generation gaps in medical education implications for teaching and learning caroline haynes, md, phd

Generation Gaps in Generation Gaps in Medical EducationMedical Education

Implications for Teaching and LearningImplications for Teaching and Learning

Caroline Haynes, MD, PhDCaroline Haynes, MD, PhD

Why the interest in generational Why the interest in generational differences in medicine?differences in medicine?

More generations in the workforceMore generations in the workforce Rapid pace of cultural change makes experience Rapid pace of cultural change makes experience

of generations divergeof generations diverge Medicine demands effective interactions Medicine demands effective interactions

between members of different generations and between members of different generations and cultures as emphasis on teamwork increasescultures as emphasis on teamwork increases

Need for more doctors in the workforce, making Need for more doctors in the workforce, making retention and job satisfaction importantretention and job satisfaction important

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

What generations are we talking What generations are we talking about?about?

““greatest” or “GI” generation – age 86-108greatest” or “GI” generation – age 86-108 ““silent” or “traditional” generation – age silent” or “traditional” generation – age

66-8566-85 ““baby boom” generation – age 49-65baby boom” generation – age 49-65 ““Generation X” – age 29-48Generation X” – age 29-48 ““millennial”, “Gen Y”, “echo-boom” or millennial”, “Gen Y”, “echo-boom” or

“nexters” generation – age 9-28“nexters” generation – age 9-28

Characteristics of Baby BoomersCharacteristics of Baby Boomers

optimistic, generous, permissive, rebellious, optimistic, generous, permissive, rebellious, ambitious, individualisticambitious, individualistic

parents were: relaxedparents were: relaxed married later, divorce rate doubledmarried later, divorce rate doubled gender gap: wide but pressure to changegender gap: wide but pressure to change prized values: youth, health, personal success, prized values: youth, health, personal success,

material wealth, “live to work”material wealth, “live to work” experience: civil rights, women’s lib, Cold War, experience: civil rights, women’s lib, Cold War,

moon landing, Vietnam, birth controlmoon landing, Vietnam, birth control technology: TV, LPs, 8mm films, mainframe technology: TV, LPs, 8mm films, mainframe

computers, plane travel, digital “immigrants”computers, plane travel, digital “immigrants”

A Cultural Icon for BoomersA Cultural Icon for Boomers

http://www.youtube.cohttp://www.youtube.com/watch?v=9tktUfZXm/watch?v=9tktUfZXHw8&feature=relatedHw8&feature=related

Cultural Messages to Baby BoomersCultural Messages to Baby Boomers

Be where you’re supposed to be when Be where you’re supposed to be when you’re supposed to be there, do your bestyou’re supposed to be there, do your best

Obey authority, respect your eldersObey authority, respect your elders Stick with the company, work your way upStick with the company, work your way up Hard work will pay off, time is money, go Hard work will pay off, time is money, go

for it!for it! You can’t take it with you, and you’re You can’t take it with you, and you’re

worth itworth it

Characteristics of Generation XCharacteristics of Generation X

fun-loving, self-reliant, troubled, cynical, fun-loving, self-reliant, troubled, cynical, “misunderstood”“misunderstood”

parents were: underprotectiveparents were: underprotective gender gap: narrowinggender gap: narrowing prized values: diversity, balance, free time, prized values: diversity, balance, free time,

environment, work to liveenvironment, work to live experience: working/single parents, space experience: working/single parents, space

shuttle, Chernobyl, Watergate,“latchkey” kids shuttle, Chernobyl, Watergate,“latchkey” kids technology: cable, PCs, internet, solar power, technology: cable, PCs, internet, solar power,

cassettes/CDs, VCRs, calculators, first digital cassettes/CDs, VCRs, calculators, first digital “natives”“natives”

Characteristics of MillennialsCharacteristics of Millennials family-oriented, mobile, consumerist, brand family-oriented, mobile, consumerist, brand

conscious, hopeful, idealistic, praise-hungryconscious, hopeful, idealistic, praise-hungry parents were: protective, “helicopter” styleparents were: protective, “helicopter” style gender gap: narrowgender gap: narrow marrying earlier again, kids when youngermarrying earlier again, kids when younger prized values: tolerance, cooperation, prized values: tolerance, cooperation,

connection/communication, novelty, connection/communication, novelty, conformity/perfectionconformity/perfection

experience: one Germany, AIDS, Kosovo, experience: one Germany, AIDS, Kosovo, Sudan, Rwanda, Iraq, 9/11, climate changeSudan, Rwanda, Iraq, 9/11, climate change

technology: VCRs to TiVo, IM/texting, cell technology: VCRs to TiVo, IM/texting, cell phones, MP3s and iPods, hybrid cars, true phones, MP3s and iPods, hybrid cars, true digital “natives”digital “natives”

Cultural Icons for MillennialsCultural Icons for Millennials

http://www.youtube.cohttp://www.youtube.com/watch?v=L-tUd_Ji-m/watch?v=L-tUd_Ji-AY&feature=relatedAY&feature=related

http://www.youtube.com/watch?v=WkPh8As-y6E

Cultural Messages to MillennialsCultural Messages to Millennials You are special and you can be anything you You are special and you can be anything you

want to bewant to be I like you just the way you areI like you just the way you are Be yourself, do your own thingBe yourself, do your own thing Be nice!Be nice! Be happy, have fun! Be happy, have fun! Things are importantThings are important Believe in yourself (focus on self-esteem inBelieve in yourself (focus on self-esteem in

parenting and education)parenting and education)

““Helicopter” parents of “trophy” childrenHelicopter” parents of “trophy” children

Often signed them up for preschool before Often signed them up for preschool before birthbirth

Gave choices rather than saying “no”Gave choices rather than saying “no” Showered kids with material goodsShowered kids with material goods Defended kids rather than teacher if Defended kids rather than teacher if

trouble at schooltrouble at school Invested time and money in multiple Invested time and money in multiple

lessons and activitieslessons and activities Allowed missing school for special eventsAllowed missing school for special events Hovered and rescuedHovered and rescued

Social class may also influence Social class may also influence parenting style-parenting style-

““natural growth” (lower)natural growth” (lower) Unstructured time, kids create own activitiesUnstructured time, kids create own activities Schooling left up to teachers, parents may Schooling left up to teachers, parents may

feel powerless and transmit this to kidsfeel powerless and transmit this to kids Authority figures and adults not to be Authority figures and adults not to be

questionedquestioned ““concerted cultivation” (middle and upper)concerted cultivation” (middle and upper)

foster talents through organized activitiesfoster talents through organized activities emphasis on speaking with adults, may emphasis on speaking with adults, may

question adults and consider them equalsquestion adults and consider them equals parental involvement in academicsparental involvement in academics

? Is a new life stage needed to describe the ? Is a new life stage needed to describe the experience of Millennials?experience of Millennials?

InfancyInfancy Early ChildhoodEarly Childhood LatencyLatency AdolescenceAdolescence Emerging Adulthood (17-27)Emerging Adulthood (17-27) Early adulthoodEarly adulthood Middle adulthoodMiddle adulthood Late adulthoodLate adulthood

The educational background of The educational background of Millennial students has included:Millennial students has included:

““grade inflation”, lots of positive feedbackgrade inflation”, lots of positive feedback trophies and awards for participationtrophies and awards for participation emphasis on individual interpretation, emphasis on individual interpretation,

independent study, “free” writingindependent study, “free” writing allowed absences for trips, competitionsallowed absences for trips, competitions relaxed dress codes, or none at allrelaxed dress codes, or none at all no scheduled classes for early AM or no scheduled classes for early AM or

Fridays (some colleges) Fridays (some colleges)

The medical school admissions The medical school admissions process rewards:process rewards:

extraordinary accomplishment in extraordinary accomplishment in endeavors other than academic (sports, endeavors other than academic (sports, arts, community service)arts, community service)

students who have been intensely students who have been intensely coached to take SAT/AP/MCAT examscoached to take SAT/AP/MCAT exams

students who are used to taking on students who are used to taking on leadership roles and having a say in thingsleadership roles and having a say in things

students for whom exceptions have been students for whom exceptions have been made and have a sense of being specialmade and have a sense of being special

So, what do Millennial students So, what do Millennial students expect in their medical education?expect in their medical education?

high quality, technically proficient learning high quality, technically proficient learning activities, efficient use of their timeactivities, efficient use of their time

exceptions to attendance rules for special exceptions to attendance rules for special events and activitiesevents and activities

a lot of positive feedback and good gradesa lot of positive feedback and good grades to take on leadership roles and have a say to take on leadership roles and have a say

in how things workin how things work that we will be invested in their success that we will be invested in their success

and help them get into the “right” and help them get into the “right” residencyresidency

Where do the generations clash?Where do the generations clash? What is disrespectful?What is disrespectful?

Students expect immediate evaluation and Students expect immediate evaluation and negotiation, criticism is mistreatmentnegotiation, criticism is mistreatment

Professors expect attendance, punctuality, Professors expect attendance, punctuality, dress code, not to be challenged about dress code, not to be challenged about grades/rulesgrades/rules

Whose time is it, anyway?Whose time is it, anyway? Lecture attendance has droppedLecture attendance has dropped Time off for special events and personal Time off for special events and personal

needsneeds

““What do you mean, close my laptop?”What do you mean, close my laptop?” Students feel entitled to constant contact and Students feel entitled to constant contact and

access to internet, teachers can’t imagine access to internet, teachers can’t imagine they are paying attentionthey are paying attention

““You said I was doing fine, why didn’t I get You said I was doing fine, why didn’t I get an “honors” grade?”an “honors” grade?” Students expect coaching and feedback that Students expect coaching and feedback that

helps them maximize their grade, teachers helps them maximize their grade, teachers expect to have authority to judge and stratify expect to have authority to judge and stratify without providing a lot of feedbackwithout providing a lot of feedback

So, are these differences real?So, are these differences real?

Are they related to generational effects, or Are they related to generational effects, or simply to age, current role or life experience?simply to age, current role or life experience?

Longitudinal data are lacking!Longitudinal data are lacking!

Borrero et al 2008Borrero et al 2008University of PittsburghUniversity of Pittsburgh

Study of residents (average age 28) and faculty (average Study of residents (average age 28) and faculty (average age 42) responding to 16 vignettes depicting lapses in age 42) responding to 16 vignettes depicting lapses in professional behavior in physiciansprofessional behavior in physicians

Rated scenarios as not a problem, minor, moderate, or Rated scenarios as not a problem, minor, moderate, or severe problemsevere problem

For all vignettes, wide variation in responses within each For all vignettes, wide variation in responses within each age group as to the severity of the lapseage group as to the severity of the lapse

For only two vignettes, significant differences between For only two vignettes, significant differences between groups:groups:

Abuse of power by resident over intern – residents say worseAbuse of power by resident over intern – residents say worse Resident signs out potentially emergent patient situation to Resident signs out potentially emergent patient situation to

cross-cover without full alert to seriousness – faculty say worsecross-cover without full alert to seriousness – faculty say worse

2008 Generational Attitudes Survey 2008 Generational Attitudes Survey Results from GSA/OSR groups:Results from GSA/OSR groups:

Survey sent to listservs for student affairs Survey sent to listservs for student affairs deans and med student representatives to deans and med student representatives to OSR from all US schoolsOSR from all US schools

466 responses from four generations 466 responses from four generations (16 silent, 138 boomers, 96 GenX, 212 (16 silent, 138 boomers, 96 GenX, 212 Millennials) –about 50% response rateMillennials) –about 50% response rate

Silent and Boomer groups are facultySilent and Boomer groups are faculty Gen X and Millennials almost all studentsGen X and Millennials almost all students

I learn most efficiently when I:I learn most efficiently when I:

0

5

10

15

20

25

30

35

40

45

listen, takenotes

read, takenotes

discuss withothers

manualactivity

SilentBoomGen XMillennial

I learn most effectively when I I learn most effectively when I have:have:

01020304050607080

peace and quiet

someback- groundstim- ulation

a lotgoing on


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

0

10

20

30

40

50

60

70

80

all of the time most of thetime

some of thetime

rarely orwhen

required


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

0

10

20

30

40

50

60

Fine, it'smy choice

OK, butmay have

missedsomething

guilty orafraid


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

0

10

20

30

40

50

60

presenterpreference

classcontentrequires

presence ofpatient

shouldalways beallowed


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

0

10

20

30

40

50

60

70

80

90

100

greatvalues- is a

"good"person

personalvalue to meas teacher,

etc.

professionalaccomplish-

ments

high rankor title


My typical approach to rules is:My typical approach to rules is:

0102030405060708090

complyunlessmorally

unaccep- table

complywithoutmuch

question

not comply if no

conse- quence

SilentBoomerGen XMillennial

My typical approach to rules is:My typical approach to rules is:

0102030405060708090

complyunlessmorallywrong

complyif I

agree withrule

complyif

respect maker

complyto stayout oftrouble

SilentBoomerGen XMillennial

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

0

10

20

30

40

50

60

70

80

90

throughoutcareer

temporarilyduring some

periods

rarely, it's a full-time job

SilentBoom - MDsGen XMillennial

I see being a physician as:I see being a physician as:

0

10

20

30

40

50

60

70

a callingthat directs

lifedecisions

a way tocontribute

to the world

a type ofemploy-

ment

start of mycareer,other

endeavorslate

Silent - MDsBoom - MDsGen XMillennial

What can we do better to bridge the What can we do better to bridge the “generation gap” in medical education ?“generation gap” in medical education ?

assimilate technology assimilate technology

Faculty can improve use of technology- consult Faculty can improve use of technology- consult with students/residents – use PPT appropriately, with students/residents – use PPT appropriately, use visuals, websites, games, virtual realityuse visuals, websites, games, virtual reality

Decide if an event really needs students in Decide if an event really needs students in attendance – if not, use technology to present it attendance – if not, use technology to present it and don’t be offendedand don’t be offended

If your teaching style is disrupted by people on If your teaching style is disrupted by people on computers and phones, say socomputers and phones, say so

Ask students how to communicate with themAsk students how to communicate with them


give feedback and coachgive feedback and coach

-let students know what you expect up front and -let students know what you expect up front and establish learning goals/objectives, and help establish learning goals/objectives, and help students prioritize their timestudents prioritize their time

-learn how to give constructive feedback, and do it -learn how to give constructive feedback, and do it regularlyregularly

-write thoughtful, personalized, and timely -write thoughtful, personalized, and timely comments when you evaluate studentscomments when you evaluate students

-when you criticize, make it about a specific -when you criticize, make it about a specific behavior, not the student as a person, and behavior, not the student as a person, and suggest how to improvesuggest how to improve


include students in decision-makinginclude students in decision-making

-to get their ideas about what will work, to -to get their ideas about what will work, to learn from their wealth of experienceslearn from their wealth of experiences

-to have them be ambassadors for your -to have them be ambassadors for your coursecourse

-to teach (and learn!) teamwork-to teach (and learn!) teamwork

-to teach the next generation how to teach!-to teach the next generation how to teach!


expect requests for exceptions/absencesexpect requests for exceptions/absences

--develop clear attendance and performance policies in develop clear attendance and performance policies in advance, explain what is negotiableadvance, explain what is negotiable

-consider whether the student can meet your course -consider whether the student can meet your course objectives despite the exceptionobjectives despite the exception

-consider the worth of the exception in the student’s overall -consider the worth of the exception in the student’s overall medical education, and its potential for your programmedical education, and its potential for your program

-consider whether you would expect to be able to take this -consider whether you would expect to be able to take this opportunity yourself in your career (e.g. to go to your opportunity yourself in your career (e.g. to go to your brother’s wedding), and teach/model how to handle itbrother’s wedding), and teach/model how to handle it


expect students to be “connected” expect students to be “connected”

--set clear policies for phone/computer use and set clear policies for phone/computer use and limits on divulging patient informationlimits on divulging patient information

-realize they expect you to be connected, too- let -realize they expect you to be connected, too- let them know how to reach youthem know how to reach you

-expect sharing of information and working -expect sharing of information and working together unless there is a penalty together unless there is a penalty

-see the benefit in forming functional teams -see the benefit in forming functional teams

The Millennial The Millennial

Look out the Millennials are coming…Look out the Millennials are coming…

Challenges that lie ahead for our Challenges that lie ahead for our students and our profession:students and our profession:

Students like novelty, but a lot of medicine Students like novelty, but a lot of medicine will deal with chronic disease managementwill deal with chronic disease management

We need more primary care doctors, but We need more primary care doctors, but loan debt is skyrocketing and more loan debt is skyrocketing and more students are choosing better-paying and students are choosing better-paying and “lifestyle” specialties to maintain work/life “lifestyle” specialties to maintain work/life balancebalance

We are facing a doctor shortage but the We are facing a doctor shortage but the hours people are willing to work are lesshours people are willing to work are less

But, what opportunities lie ahead that But, what opportunities lie ahead that Millennials are well-suited for?Millennials are well-suited for?

-rapid pace of technological advances-rapid pace of technological advances

-use of communications technology to -use of communications technology to receive and share informationreceive and share information

-increasing cultural diversity-increasing cultural diversity

-global healthcare initiatives-global healthcare initiatives

-achieving equity in healthcare as a social -achieving equity in healthcare as a social justice issuejustice issue

-conformity to increasing compliance and -conformity to increasing compliance and performance standardsperformance standards

How can the Millennials help usHow can the Millennials help ustransform medicine?transform medicine?

““The reality is that, increasingly, the world around us is The reality is that, increasingly, the world around us is focused less on the achievements of individual experts, focused less on the achievements of individual experts, and more on collaboration between individuals and and more on collaboration between individuals and groups to solve complex problems………groups to solve complex problems………

Our culture code needs to be…collaborative, transparent, Our culture code needs to be…collaborative, transparent, outcomes-focused, mutually accountable, team-based, outcomes-focused, mutually accountable, team-based, service-oriented and patient-centered.”service-oriented and patient-centered.”

Darrell Kirch, M.D.Darrell Kirch, M.D.President and CEOPresident and CEOAAMC President’s AddressAAMC President’s Address

November, 2007November, 2007

The young do not know enough to be The young do not know enough to be prudent, and therefore they attempt the prudent, and therefore they attempt the impossible, and achieve it, generation impossible, and achieve it, generation after generationafter generation

Pearl S. BuckPearl S. Buck

generation gaps in medical education implications for teaching and learning caroline haynes, md, phd

Documents

generation x age

nexters generation age

traditional generation

gi generation age

baby boom generation

generation gaps

related slide

experience of generations