Millennium Generation Poses New Implications for Surgical Resident Education

If you poll a group of surgeons about their impressions of current residents, almost universally they will express feedback that the trainees are “different” from previous generations. Commonly perceived differences include a lack of hierarchy observance, prioritization of life versus work, and a sense of entitlement. Of course, some of these attitudes are subjective and perhaps arise from staff ignoring their own deficiencies. However, there is an increasing body of literature that supports some of the apparent differences between generations of surgeons at various stages of their careers.

Several articles focus on how generational differences impact modern medical education.^1,2 There are no randomized trials or large prospective studies; these articles have essentially been expert opinion or small single-center studies. Regardless, there appears to be a common theme related to the typical characteristics of each generation and the explanation of the origin of these characteristics.

This article will provide background about currently recognized generations, each generation’s general characteristics, and the underlying reasons researchers have suggested for generational differences. An understanding of the typical characteristics of older generations coupled with an understanding of the characteristics of the newer generations of residents will likely facilitate and optimize the teaching of these trainees. Hopefully, an appreciation of the newer generations will dispel some of the misconceptions and lead to more tolerance of the differences.

Each generation has been designated as defined by its demographics, shaped by common history, and influenced by common events. Because of similar experiences and exposure to culture as a child, individuals within a given generation share a similar behavior and have comparable values.³

Current trainees involved in surgical residencies are part of Generation Y, otherwise known as the Millennials. These students were born between approximately 1981 and 1999, with some disagreement relating of the exact beginning and end of the generation.^2,4 Millenials are essentially the children of the Baby Boomers (born between 1943 and 1960) and grew up with cultural events that include 9/11, smartphones, and Tiger Woods.

As a group, the Millennials are educated, skilled, comfortable with technology, and very self-confident. They score higher on intelligence tests, although are less likely to read books when compared to preceding generations.³ They have been protected and sheltered by their parents, who are sometimes referred to as “helicopter parents” because of their tendency to hover over their children.⁵ This behavior has been suggested to perpetuate adolescence and delay a Millennial’s development of independence. Measured against traditional developmental milestones, some believe that Millennials are less mature than preceding generations and many express doubt about their abilities and readiness to accept responsibility.^5,6 On the other hand, supportive parents have encouraged them to aim for success. Furthermore, they are accustomed to being tested, receiving feedback, and achieving clearly set goals.⁴

Generation Y is the first generation that has information readily available with the click of a mouse. Consequently, they are demanding educational consumers and desire instant results. They have high expectations for the availability and usefulness of technology. Overall, they are team oriented and value being connected with others.⁷

The Millennials are more likely to expect significant leisure time.³ Studies have shown that younger generations favor jobs that have no overtime and provide extended vacations. As an example, the number of medical students going into specialties with more sociable hours (for example, dermatology and anesthesiology) has increased, while the number of students choosing general surgery and family practice has declined.³

In contrast to the Millennials, the surgeons involved in educating these residents are either part of the Baby Boomer Generation (1943–1960) or Generation X, also known as Gen X, (1961–1980). Baby Boomers have been impacted by the introduction of television, civil rights, the Vietnam War, and the Space Race. Typical characteristics have been described as competitive, optimistic, consumeristic, and that they live to work.⁸ Generation X individuals were raised by the live-to-work Baby Boomers and often raised in single-parent households. Direct supervision and family bonding were challenged. Therefore, as a group, Generation X is cynical, skeptical, and pessimistic. They are private and likely to take care of their own needs. They are sometimes called the “Me Generation” being self-motivated, independent, and pragmatic.⁷

To complete defining the generations, those in the Traditionalist Generation were born between 1900 and 1942. These individuals grew up in the Great Depression and World War II.⁹ They are classically loyal and patriotic, and have respect for authority. There are few surgeons of the Traditionalist Generation who are still active in education of surgical residents.

A summary table of the current generations is provided below.

Table 1: The Generations—Years, Events, and Characteristics

Given the generational differences described before, there is no doubt that approaches to teaching utilized for past generations may not be successful for the Millennial Generation. However, with an understanding of the differences, establishing successful teaching and mentoring strategies for Millennial residents is possible. It is likely that some of the following suggestions have already been incorporated by many medical educators.

Technology

The Millennials have grown up in a time of compact discs, the Internet, computers, cell phones, iPods, and tablets. They have no memory of a time without a computer. Accordingly, Millennials are very competent and comfortable with technology. They interact with these devices every day and, because of their comfort, prefer some forms of education be presented via this technology, including online learning modules such as the SCORE Curriculum, blogs, online question banks, and podcasts. With the increasing availability of electronic resources, Millennial students are less likely to go to the library or read textbooks.³ Therefore, investment in and utilization of these modern forms of media is likely to be beneficial for Millennial residents.

Authors have suggested that Millennial residents will interpret good medical educators as those who keep abreast of new technologies and incorporate them into teaching.¹ Some of the most successful strategies suggested include employing simulation and group discussions. The traditional didactic lectures will not be as well received. If using a lecture format, it should incorporate additional features such as multimedia, audience participation, and utilization of contextual teaching (for example, case presentations).^1,2,6

Multitaskers

The Millennial generation is accustomed to constant interactions via telephone, text messaging, and e-mail. Consequently, this type of scenario does lead to some challenges for the medical educator. As an example, it is not unusual for staff surgeons to be talking with the patient on rounds, while individuals in the Millennial generation answer text messages, hold a discussion with a fellow resident, and complete computer order entry. These multitasking activities may be interpreted as disrespectful behavior by educators, but for Millennials, they are second nature.⁶ In fact, the Millennial resident may be oblivious that his or her behavior may be interpreted as rude or disrespectful.² To successfully tackle this issue, the expected conduct and rules of acceptable behavior need to be clearly delineated. In addition, the faculty should act as role models for appropriate behavior by avoiding multitasking (for example, avoid use of handheld devices during morbidity and mortality conferences and grand rounds).

Work–Life Balance

There is often the perception expressed by more senior generations that Millennial residents are unmotivated. This misconception was likely accentuated by the introduction of the 80-hour work week restrictions, coupled with the “it was harder back in my day” perspective. The Millennials express that they simply desire a balance of work and life.^2,4 The number of doctors choosing to work part time has significantly increased in the new millennium.³ To state it a different way, Baby Boomers are described as the generation that live to work, while Millennials work to live. It is likely that the same debate over professionalism occurs every time a new generation enters medicine.²

The most beneficial way to address professionalism in the Millennial generation is to be explicit about rules and expectations. Some behaviors, thought to be common sense by older generations, will need to be clearly defined, including appropriate dress, punctuality, multitasking during lectures, and expectations for patient care.

Team Approach

The majority of Millennial residents grew up doing group activities and playing on teams. Working independently represents a greater potential for personal failure. Therefore, overall Millennials prefers to work cooperatively on projects.^4,5,9 Understandably, not all residency training can be achieved as a group assignment. However, some components of the curriculum may be amenable to team collaboration.

Highly Structured Lives

As stated above, Millennial students have experienced highly structured lives from birth. Their parents encouraged participation in school and extracurricular activities, all of which were carefully planned.^1,6 This prolonged exposure to imposed structure and parental supervision has led Millennials to be uncomfortable without a schedule and find it difficult to manage a busy schedule of their own. The consequence for surgical residents is that they may require guidance from mentors about how to balance and prioritize the multiple duties in residency.²

Absence of Hierarchy

Millennials have had close relationships with authority figures, in the form of their parents, all of their lives. Consequently, they may not recognize hierarchy to the same degree that senior generations do. They see their Professors as equals and expect their supervisors to be approachable and supportive, and to care about them personally, like their parents did.² The end result being that they may be unaware of some perceived social norms and be overly casual with senior staff.

Overcoming this obstacle requires a certain degree of tolerance on the part of the senior generations and clear feedback provided to Millennial residents about acceptable conduct.

Feedback

Millennials are accustomed to having set clear goals, achieving those goals, and subsequently receiving rewards as a result.⁴ In addition, they have grown up in the age of convenient and instantly available information. The combination has led to a need for clear objectives to be stated, in association with immediate feedback. They want to know without delay if they are doing anything right or wrong. At the same time, however, they are often unprepared to accept negative feedback or even constructive criticism, because they have only received positive reinforcement from parents in the past.²

Thus the approach to teaching Millennials should include telling them what they need to know and why. Feedback needs to be very specific, clear, and simple. In addition, it should be frequent and behaviorally based.^2,4

Undoubtedly, each generation differs in terms of their social skills, tendencies, and attitudes. Some of these characteristics are advantages and others represent challenges to traditional teaching methods. Knowledge and understanding of the differences between generations represents an opportunity to improve medical education for the next generation. Although traditional methods of teaching should not be completely abandoned, new approaches utilizing technology, audience participation, and contextual learning will be necessary.

These modern learners should be viewed more appropriately as consumers of education. They want to know the value or worth of what is being taught, it must be relevant, and its relevance must be clearly conveyed to the residents. In addition, they will demand frequent and clear feedback. At times, they will also need guidance about acceptable and expected professional behavior.

Finally, it will be necessary to help residents realize that work may at times take precedence over the rest of their lives. However, at the same time, it is necessary for older generations to respect the residents’ lives outside of the program.

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