Medical Education for the “Echo Boomer” Generation Medical Education Grand Rounds: Friday, October 31, 2008 Morton H. Levitt, MD, MHA, FCAP Clinical Professor

Medical Education for theMedical Education for the “Echo Boomer” “Echo Boomer”

GenerationGenerationMedical Education Grand Rounds: Friday, October 31, 2008Medical Education Grand Rounds: Friday, October 31, 2008

Morton H. Levitt, MD, MHA, FCAPMorton H. Levitt, MD, MHA, FCAPClinical Professor of Biomedical Science,Clinical Professor of Biomedical Science,

University of Miami Miller School of Medicine, Charles E.University of Miami Miller School of Medicine, Charles E.Schmidt College of Biomedical Science, Regional CampusSchmidt College of Biomedical Science, Regional Campus

at Florida Atlantic Universityat Florida Atlantic UniversityUniversity, Boca Raton, FLUniversity, Boca Raton, FL

Who Are the Echo Who Are the Echo Boomers?Boomers?

A “generational cohort,” the “echo A “generational cohort,” the “echo boomers,” were born between 1981 boomers,” were born between 1981 and 2000. They are <27 years old.and 2000. They are <27 years old.

These are many of our med These are many of our med students.students.

Generational cohorts are groups of Generational cohorts are groups of people, usually born in the same 20-people, usually born in the same 20-year time span, who share common life year time span, who share common life experiences and thus share common experiences and thus share common attitudes and traits.attitudes and traits.

See Kruse, “Buckle Up; Generation Y is Here” at http://www.clomedia.com/content/templates/clo_col_elearning.asp?articleid=410&zoneid=46

Four Generations: Our workforce Four Generations: Our workforce today arguably consists of four today arguably consists of four

major generations: major generations:

1.1. Veterans/Matures: 1922-1943 Veterans/Matures: 1922-1943 (>62)(>62)

2.2. Boomers: 1943-1960 (42-62)Boomers: 1943-1960 (42-62) 3. 3. Gen X’ers: 1960-1980 (27-42)Gen X’ers: 1960-1980 (27-42) 4. 4. Gen Y’ers/Nexters/Millennials/Echo Gen Y’ers/Nexters/Millennials/Echo

Boomers: 1980-2000 (<27)Boomers: 1980-2000 (<27)

But Our Medical and Graduate But Our Medical and Graduate Students are GenXers and Students are GenXers and

GenYersGenYers They share many common They share many common

attributesattributes They are very different than their They are very different than their

predecessorspredecessors Learning methods for them must Learning methods for them must

take into account their unique take into account their unique characteristicscharacteristics

GenXers 1960-1980GenXers 1960-1980

CORE VALUESCORE VALUES DiversityDiversity Thinking GloballyThinking Globally SurvivalSurvival Self relianceSelf reliance

SEMINAL EVENTSSEMINAL EVENTS 1970 Women’s Liberation Protests1970 Women’s Liberation Protests 1973 Watergate Scandal1973 Watergate Scandal 1979 Three mile Island Nuclear 1979 Three mile Island Nuclear

MeltdownMeltdown Massive Corporate LayoffsMassive Corporate Layoffs 1987 Stock Market Plummets1987 Stock Market Plummets 1991 Operation Desert Storm1991 Operation Desert Storm


HEROESHEROES None (no one famous but you None (no one famous but you

can inspire Xer loyalty)can inspire Xer loyalty)


ASSETS ON THE JOBASSETS ON THE JOB AdaptableAdaptable IndependentIndependent Unintimidated by AuthorityUnintimidated by Authority CreativeCreative


LIABILITIESLIABILITIES ImpatientImpatient Poor People SkillsPoor People Skills InexperiencedInexperienced CynicalCynical


Nexters/Millenials/Y’ers/Echo Nexters/Millenials/Y’ers/Echo Boomers 1980-2000Boomers 1980-2000

CURRENT CORE VALUESCURRENT CORE VALUES OptimismOptimism Civil DutyCivil Duty ConfidenceConfidence AchievementAchievement SociabilitySociability MoralityMorality Street SmartsStreet Smarts DiversityDiversity

SEMINAL EVENTS/TRENDSSEMINAL EVENTS/TRENDS Violence: Oklahoma City Violence: Oklahoma City

BombingBombing Clinton/LewinskyClinton/Lewinsky Columbine High School MassacreColumbine High School Massacre Child FocusChild Focus TechnologyTechnology StressStress

Nexters/Millenials/Echo Boomers Nexters/Millenials/Echo Boomers 1980-20001980-2000

HEROESHEROES Michael JordanMichael Jordan Princess DianaPrincess Diana Mother TeresaMother Teresa Bill GatesBill Gates Tiger WoodsTiger Woods Christopher ReeveChristopher Reeve


ASSETS ON THE JOBASSETS ON THE JOB Collective Action/TeamworkCollective Action/Teamwork OptimismOptimism TenacityTenacity Multitasking CapabilitiesMultitasking Capabilities Technological SavvyTechnological Savvy


LIABILITIESLIABILITIES Need for supervision and Need for supervision and

structurestructure Inexperienced particularly when Inexperienced particularly when

handling difficult people issueshandling difficult people issues


Common Learning Characteristics of Gen X

and Gen Y Students* Want to be recognized as individualsWant to be recognized as individuals Want a voice in class decisionsWant a voice in class decisions Want to establish rapport with the Want to establish rapport with the

instructorinstructor Value group interactionsValue group interactions View class time as social and View class time as social and

educational experienceeducational experience Need nonjudgmental sounding boardNeed 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 Don’t like being passive recipients of

informationinformation Must be engaged to retain informationMust be engaged to retain information Want a variety of learning experiencesWant a variety of learning experiences Are used to being entertainedAre used to being entertained Need course work that must be Need course work that must be

relevant to the real worldrelevant to the real world Want to learn marketable skillsWant to learn marketable skills Want information to be currentWant information to be current


So, Here’s the Question:So, Here’s the Question:

Do Echo Boomers and Gen Xers Do Echo Boomers and Gen Xers (our current medical and (our current medical and graduate students) require graduate students) require different approaches to learning different approaches to learning than I did?than I did?

Yes, …So How do We Teach Yes, …So How do We Teach Them?Them?

Medical Education andMedical Education and the Echo Boomers: A Relevant the Echo Boomers: A Relevant

QuoteQuote ““Generation Y is Generation Y is much less likely to

respond to the traditional command-and-control type of management still popular in much of still popular in much of today's workforce," says Jordan Kaplan, today's workforce," says Jordan Kaplan, an associate managerial science an associate managerial science professor at Long Island University-professor at Long Island University-Brooklyn in New York. "They've grown Brooklyn in New York. "They've grown up questioning their parents, and up questioning their parents, and now now they're questioning their they're questioning their employersemployers. They don't know how to . They don't know how to shut up, which is great, but that's shut up, which is great, but that's aggravating to the 50-year-old manager aggravating to the 50-year-old manager who says, 'Do it and do it now.' " who says, 'Do it and do it now.' "

Bruce Tulgan, a founder of New Haven, Conn.-based RainmakerThinking

Medical Education andMedical Education and the Echo Boomers the Echo Boomers

Unlike “baby boomers” who tend Unlike “baby boomers” who tend to put a high priority on career, to put a high priority on career, today's youngest workers are today's youngest workers are more more interested in making interested in making their jobs accommodate their their jobs accommodate their family and personal lives.family and personal lives. They want jobs with flexibility, They want jobs with flexibility, telecommuting options and the telecommuting options and the ability to go part time or leave the ability to go part time or leave the workforce temporarily when workforce temporarily when children are in the picture. children are in the picture.

Cited from Stephanie Armour Generation Y: USA Today accessed Dec 12, 2006 at http://www.usatoday.com/money/workplace/2005-11-06-gen-y_x.htm

Learning Theories and the Learning Theories and the Echo BoomerEcho Boomer

Technology has changed the way Technology has changed the way we deliver learningwe deliver learning

Do we still teach students with Do we still teach students with an “industrial age” mentality?an “industrial age” mentality?

Have we moved from the Have we moved from the industrial era to the knowledge industrial era to the knowledge era?era?

From “Reshaping the Way We View the World, Chalofsky, N., TDNov2005.


In The Fifth Discipline [New York, In The Fifth Discipline [New York, Doubleday, 1990), Peter Senge Doubleday, 1990), Peter Senge writes:writes:

In the Industrial Era, the machine In the Industrial Era, the machine was the focus of productionwas the focus of production

In the Knowledge Era, the human In the Knowledge Era, the human mind is the focusmind is the focus


In the Knowledge Era, the In the Knowledge Era, the learning institution needs to be:learning institution needs to be: Transforming: continually adapting Transforming: continually adapting

to changeto change Emphasize self-directed learningEmphasize self-directed learning Move away from internal Move away from internal

competition to cooperation, competition to cooperation, collaboration, and networkingcollaboration, and networking


The learning organization creates The learning organization creates a purposeful learning a purposeful learning environment, at the individual, environment, at the individual, group, and organizational level, group, and organizational level, for the mutual benefit of the for the mutual benefit of the individual and the organizationindividual and the organization


Russell Ackoff, Professor Russell Ackoff, Professor Emeritus of the Wharton School Emeritus of the Wharton School talks about a “spectrum of talks about a “spectrum of learning:”learning:” DataDataInformationInformationKnowledgeKnowledge

UnderstandingUnderstandingWisdomWisdom Traditional medical school Traditional medical school

education focuses on education focuses on establishing a “knowledge base”establishing a “knowledge base”

Dr. Ackoff is Professor Emeritus of the Wharton School and Chairman of Interact, the Institute for Interactive Management.

See his book Introduction to Operations Research, co-authored with C. West Churchman

http://en.wikipedia.org/wiki/Wharton_School

http://en.wikipedia.org/wiki/C._West_Churchman


In the Industrial Era, there was In the Industrial Era, there was an outcome for every cause of an outcome for every cause of action (“cause-effect” principle)action (“cause-effect” principle)

In the Knowledge Era, as in In the Knowledge Era, as in traditional medicine, there may traditional medicine, there may not be just one specific causal not be just one specific causal link for every problemlink for every problem

Multiple ways of viewing reality Multiple ways of viewing reality imply multiple ways of learningimply multiple ways of learning


There are different ways students There are different ways students learn and acquire knowledgelearn and acquire knowledge

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

http://www.infed.org/thinkers/et-lewin.htm#actionresearch



What if medical schools shift to a What if medical schools shift to a true “learning orientation,” re-true “learning orientation,” re-examine theexamine the

traditional “performance traditional “performance orientation,” and develop a orientation,” and develop a curriculum that is curriculum that is intrinsically intrinsically motivatingmotivating??


A learning orientation focuses on A learning orientation focuses on the goal as a challenge that the goal as a challenge that sparks a desire to learn and try sparks a desire to learn and try new ways to do it better.new ways to do it better.

Those with a true learning Those with a true learning orientation achieve higher levels orientation achieve higher levels of productivity, and do it with of productivity, and do it with more enjoyment and satisfactionmore enjoyment and satisfaction


Today’s typical medical school Today’s typical medical school curriculum: very simplified*curriculum: very simplified*

Preclinical curriculum/basic Preclinical curriculum/basic sciencessciences

Clinical curriculumClinical curriculum ElectivesElectives Assessment of medical studentsAssessment of medical students

*See AAMC’s Curriculum Directory at http://services.aamc.org/currdir/about.cfm

Medical School Teaching Medical School Teaching Methods Methods

Traditional lecturesTraditional lectures Small-group discussionSmall-group discussion Self-instructionSelf-instruction LaboratoriesLaboratories Case studiesCase studies Computer assisted instructionComputer assisted instruction Clinical venuesClinical venues

*See AAMC’s Curriculum Directory at http://services.aamc.org/currdir/about.cfm

Future Trends Will Also Future Trends Will Also Influence Medical EducationInfluence Medical Education

Courtesy of SG2. See www.sg2.com

Future Trends that will Future Trends that will Influence Medical EducationInfluence Medical Education











Courtesy of SG2. See www.sg2.com **Implantable cardioverter defibrillators (ICDs) and biventricular pacemakers for cardiac resynchronization therapy (CRT)

**



So, back to Educating So, back to Educating Tomorrow’s Gen Y DoctorTomorrow’s Gen Y Doctor

How do we align emerging and How do we align emerging and future trends in medicine with future trends in medicine with workforce needs, package the workforce needs, package the product, and make it presentable product, and make it presentable to today’s medical students?to today’s medical students?

The Generation Y Doctor:The Generation Y Doctor:Beyond KnowledgeBeyond Knowledge

Remember Ackoff’s model?Remember Ackoff’s model? DataDataInformationInformationKnowledgeKnowledgeUndUnd

er-standinger-standingWisdomWisdom The Gen Y student is obsessed The Gen Y student is obsessed

with garnering the minimum with garnering the minimum acceptable knowledge base, just acceptable knowledge base, just enough to “pass the boards,” enough to “pass the boards,” using his high-tech tools, of using his high-tech tools, of course (“Google it”), and then hit course (“Google it”), and then hit the ground running on Day 1the ground running on Day 1


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


The answer: give them what they The answer: give them what they crave:crave: High tech, computer and internet-High tech, computer and internet-

based learning toolsbased learning tools Assessment that focuses on Assessment that focuses on

performance outcomes (“see one, do performance outcomes (“see one, do one”) one”)

Focus on lifelong learning techniques Focus on lifelong learning techniques and professional developmentand professional development

Reinforce networking, collaboration, Reinforce networking, collaboration, and cooperationand cooperation


Pedagogical techniques for the Gen Pedagogical techniques for the Gen Y’er:Y’er: Small groupSmall group discussions discussions Large group Large group interactive sessionsinteractive sessions

Problem-based learnedProblem-based learned Team-based learningTeam-based learning

Practical, Practical, hands-on experiencehands-on experience from Day from Day 11

Emphasize learning techniques that go Emphasize learning techniques that go beyond rote memorization – beyond rote memorization – strive for strive for understanding and wisdomunderstanding and wisdom (“can you (“can you explain it to your mother”)explain it to your mother”)

Teaching Techniques That I Teaching Techniques That I Use at My Current SchoolUse at My Current School

The following are techniques, learned The following are techniques, learned the “hard way,” that work at the “hard way,” that work at UMMSM@FAUUMMSM@FAU

They take into account GenX/GenY They take into account GenX/GenY common attributescommon attributes

You know you are dealing with a You know you are dealing with a GenX/Yer when, on the first day, a GenX/Yer when, on the first day, a student approaches the podium and student approaches the podium and asks you:asks you:

““Do I really have to buy the textbook.”Do I really have to buy the textbook.”

Educating the Gen Y Educating the Gen Y Doctor: Ten Tips: Introduce Doctor: Ten Tips: Introduce

YourselfYourself ““Humanize” yourself: share an Humanize” yourself: share an

anecdote so they can relateanecdote so they can relate They think they are more They think they are more

technically savvy then you are: technically savvy then you are: let them know something about let them know something about your experiencesyour experiences

If you can engage them at the If you can engage them at the start, you will hold their intereststart, you will hold their interest


Educating the Gen Y Educating the Gen Y Doctor: Ten Tips: Keep it Doctor: Ten Tips: Keep it

RealReal Tell them the goals/objectivesTell them the goals/objectives Make it relevantMake it relevant Provide a personal incentive that Provide a personal incentive that

will save them time in studying, etcwill save them time in studying, etc Utilize real world examplesUtilize real world examples Provide positive examples [“this Provide positive examples [“this

slide always helps medical students slide always helps medical students understand the brachial plexus”]understand the brachial plexus”]


Educating the Gen Y Educating the Gen Y Doctor: Ten Tips: Be VisualDoctor: Ten Tips: Be Visual

Students retain only10% of Students retain only10% of written materials, but 30% of written materials, but 30% of what they see [Miller]what they see [Miller]

Text heavy slides are Text heavy slides are disadvantageous; images ruledisadvantageous; images rule

Even better are short demos or Even better are short demos or screen capturesscreen captures


Educating the Gen Y Educating the Gen Y Doctor: Ten Tips: Utilize Doctor: Ten Tips: Utilize

HumorHumor Irony and self-deprecating humor Irony and self-deprecating humor

works wellworks well Corny humor works [“ET doesn’t Corny humor works [“ET doesn’t

stand for extra-terrestrial – it stand for extra-terrestrial – it means Essential means Essential Thrombocythemia”]Thrombocythemia”]


Educating the Gen Y Educating the Gen Y Doctor: Ten Tips: CustomizeDoctor: Ten Tips: Customize

GenYers know how to customize GenYers know how to customize their personal Yahoo pages, their personal Yahoo pages, create “auto alerts” on their create “auto alerts” on their desktops, and “push” technology desktops, and “push” technology on their cell phoneson their cell phones

Show them how to customize Show them how to customize their notes and other learning their notes and other learning toolstools


Educating the Gen Y Doctor: Educating the Gen Y Doctor: Ten Tips: Design Team Ten Tips: Design Team

AssignmentsAssignments

They tend to work well togetherThey tend to work well together They respect their peers more They respect their peers more

than their instructorsthan their instructors Design group exercises such as Design group exercises such as

PBLs, small groups, etc. where PBLs, small groups, etc. where students take the lead to teach students take the lead to teach each othereach other


Educating the Gen Y Educating the Gen Y Doctor: Ten Tips: Be Doctor: Ten Tips: Be

FlexibleFlexible They are indifferent to rules and They are indifferent to rules and

regulationsregulations Let them design or define part of Let them design or define part of

the assignmentthe assignment Positives work better [“be careful Positives work better [“be careful

with your note taking” works with your note taking” works better than “don’t plagiarize!”]better than “don’t plagiarize!”]


Educating the Gen Y Educating the Gen Y Doctor: Ten Tips: Be Honest Doctor: Ten Tips: Be Honest

and Fairand Fair If you don’t know the answer, tell If you don’t know the answer, tell

them; don’t “fudge it;” they can them; don’t “fudge it;” they can see through thissee through this

If you promise to do something, If you promise to do something, follow up on itfollow up on it

These students are all too These students are all too familiar with corporate scandals, familiar with corporate scandals, dirty politicians, and dishonest dirty politicians, and dishonest adultsadults


Educating the Gen Y Doctor: Educating the Gen Y Doctor: Ten Tips: Establish Authority Ten Tips: Establish Authority

but…but… Build relationships, not hierarchal Build relationships, not hierarchal

structuresstructures Invite participation and display Invite participation and display

empathyempathy Idle threats don’t work well Idle threats don’t work well

[students will be IM’ing, chatting, [students will be IM’ing, chatting, checking e-mail, etc. – ask they checking e-mail, etc. – ask they to close there monitors for a to close there monitors for a while]while]


Educating the Gen Y Educating the Gen Y Doctor: Ten Tips: Offer HelpDoctor: Ten Tips: Offer Help

Remind them where they can get Remind them where they can get helphelp

Allow them to ask questionsAllow them to ask questions Be accessibleBe accessible They require immediate They require immediate

feedback and help when feedback and help when problems ariseproblems arise


The Echo Boomer Comes The Echo Boomer Comes Full CircleFull Circle

See www.rahc.uthscsa.edu/Faculty/12.2.pdf

I love those high tech

toys!

Documents

Medical Education for the “Echo Boomer” Generation Medical Education Grand Rounds: Friday, October 31, 2008 Morton H. Levitt, MD, MHA, FCAP Clinical Professor