A Late Y2K Phenomenon: Responding to the Learning Preferences of Generation Y—Bridging the Digital Divide by Improving Generational Dialogue

Abstract

From the first byte, computer-enabled interdepartmental communication has dramatically evolved. Generation Y is a product of this revolution and is currently the most connected generation. However, it is also the most socially isolated. The current enhanced mode of communication, although increasing the immediacy of dialogue, has also marginalized the emotional content inherent in face-to-face conversation. The growth of social media has helped to bridge the divide, albeit incompletely. Recent reports of increasing depression among medical students and residents, culminating in some instances with suicide, is occurring in this cohort at a rate twice that of the general population and is an increasing concern for their mentors and society at large. An understanding of how Generation Y is "wired" differently from preceding generations may help to anticipate this extreme response to depression and, in the process, improve intergenerational dialogue. "Children no longer obey their parents … it is evident that the end of the world is fast approaching." Assyrian tablet, c. 2, 800 B.C.E. Generation Y—which also is referred to as the Millennial Generation, the Net Generation, Generation Next, and/or Echo Boomers, and includes persons born between 1983 and 2003—appears to have radically different learning preferences compared with its predecessors 1. Members of Generation Y shop, play, learn, and communicate with one another in a manner both foreign and puzzling to persons of previous generations. As a group, members of Generation Y are multimedia aficionados whose lives and work styles have been defined by the instant communication that has been made increasingly accessible by digital technology. In the multiple-generational milieu of a residency training program, tensions between the generations can at the very least produce anxiety and, at worst, be disruptive. As the retired director of a physical medicine and rehabilitation (PM&R) residency training program that I established 25 years ago at Oakland University William Beaumont School of Medicine, in recent years I have, like the fiddler on the roof, observed the development of an increasing and disquieting tension between the clinical staff and the residents. What appears to be an abrupt and rapid alteration in learning style has, in retrospect, been an ongoing process that has occurred over a number of years. During this same period, teaching technology has also notably changed, as evidenced by the evolution of multimedia technology from glass lantern slides to 35-mm slides and now, digital-based media. Society at large has been significantly affected as the generations have succeeded each other, especially in the areas of marketing, employment, and education. Such has also been the case for PM&R residencies, and for that matter, all other residencies 2. As recent residents have entered PM&R training programs, faculty members have had to struggle to adjust to the reality of a rapidly accelerating communication gap between the generations. Like their contemporaries, PM&R residents are members of Generation Y, a group that is clearly "wired" differently than its generational predecessor and has required an innovative curriculum to facilitate its learning process. Buffalo Springfield proclaimed in a 1967 recording, "There is something happening here. What it is ain't exactly clear" 3. This sentiment, as observed by persons preceding Generation Y, becomes clearer as we note how the characteristics of these generations differ. By reviewing what each generation has brought to the educational table, we can identify a best practice to improve intergenerational communication 4. Generation Y, with its 70 million members, is the largest and best-educated generation 5 and is the successor to the preceding Generation X, as was described in 1993 in the pages of the marketing magazine Advertising Age 6. Generation Y came of age with the ubiquitous presence of computers, cell phones, and MP3 players. Instant messaging and multitasking have always been part of their daily lives. They have been emotionally affected by the disturbances of September 11, 2001, war, the current economic recession, and the energy crisis, as well as continuing concerns about global warming. These issues, singularly and together, have engendered an incessant need for connectivity, individually and with the community at large 7. In many ways, Generation Y has been forced to become much less self-serving than previous generations and has an admirable altruistic spirit. Generational boundaries are defined by group-shared age and contemporary values, as well as worldly experiences. However, it begs the obvious that although they share common childhood experiences, unique cohorts within this group also exist and distinguish themselves from the rest of their contemporaries by, among other characteristics, their innate intelligence, intellectual focus, and hard work 8. Included in this group are young physicians, that is, residents, including those in PM&R. Mindful of the educational experiences and technological skills of these residents, what teaching initiatives are appropriate to capture and hold their attention in their own learning process? The question of how to engage them academically during their formative years has been a matter of unending discussions within the educational community. However, as evidenced by their outstanding academic performance, Generation Y has not been educationally neglected during this time. The techniques that have been used successfully in this generation's ongoing educational passage should also work as well during their training as PM&R residents. A generational period lasts approximately 20 years, extending from birth to young adulthood. During a generation's formative years, it is influenced as a peer group by shared key events, each coloring its perception of the world. Each of these generational cohorts is shaped by shared reference points, that is, environmental forces, familiar events, and people. As they respond to these external events, the individual members of the generational group are likely to inculcate similar behavioral responses. As each generational cohort succeeds one another, it incorporates different perspectives as it responds to changes in popular culture and the intrusion of world events 9. Among physicians currently in the workforce, these generational differences have demanded increased attention. Across generations, alternative values and work styles, attitudes, and expectations have at times instigated intergenerational discord and, episodically, outright confrontation 10. The 2 major generations of physicians currently interfacing in the learning process are Generation Xers, born between 1965 and 1980, and Generation Yers, born between 1983 and 2003. Generation Y has not suddenly emerged de novo. Instead, it is a product of planned social engineering structured to mirror the diverse parallel demography of our contemporary society. As such, Generation Yers are as different from one another as they are from preceding generations. These generational differences, singularly and together, have often highlighted discrepancies in learning preferences, which have, with unsettling frequency, interfered with communication between the generations. All of the stakeholders involved in the learning process have come to recognize the need for a dramatic improvement in the dialogue necessary to bridge this growing communication gulf. The traditional "in-your-face" teaching style no longer works in the contemporary classroom! Through each of these generations, an essential component of the preeminent residency training program has been the presence of at least one notable physician role model. Each of these individuals has demonstrated an ability to attract quality residents. By their example they have strongly influenced residents during their training and with regard to their posttraining career choices—that is, the adoption of either an academic and/or practice affiliation 11. Although an engaging and warm personality along with an outstanding clinical acumen have been equally valued in these leaders, Generation Y has remained, with regard to a total commitment to their educational career, a hard sell. Among other factors, their restraint in this regard is influenced by their age and their previous employment history, because they are often older at the same level of training than previous generations and their medical career is often a late second choice 12. In Generation X, their immediate predecessor, power was still predominately held by white men. Long overdue gender and racial equality is now the norm in Generation Y. They too have the capacity to recognize an exceptional learning opportunity and are quick to adopt an outstanding teacher as a role model. The role model motivates by being self-assured, handling pressure in a calm manner, and demonstrating sincerity by delivering promptly on promises. He or she also treats professional colleagues, residents, and others with respect. In this process, role models must also come to develop a self-depreciating sense of humor, acknowledging that no one individual is perfect. Every staff member should be expected to become a role model and to mentor a resident, providing them with both social and professional support. Although he or she may not recognize it as such, each mentor becomes a surrogate for the now-absent "helicopter" (hovering) parent. In this relationship, residents have an opportunity to internalize the values they admire most in each mentor. In turn, the teaching staff itself benefits by learning to recognize both the positive and negative factors attributable to role modeling and is, by this experience, better able to contribute to faculty development 13, 14. As stated by Vince Lombardi in 1967, an NFL coach of the Green Bay Packers: Leaders are made, not born … he must believe that the group wants from him a sense of approval. If this feeling prevails, production, discipline, morale will be high, and in return, he can demand the cooperation to promote the goals of the community. He must walk as if it were a tightrope between consent he must win, and the control that he must exert 15. In this mentoring relationship, Generation Yers are generally more reserved than their predecessors. However, they are also more likely to respect authority, as well as value a supportive learning environment, especially when feedback is immediate. Cross-generational experiences and career goals that are shared by the mentor and mentee—for example, gender, educational and research interests, lifestyles, and family commitment—can enhance this relationship. Moreover, mentors who by happenstance are also "cuspers" (ie, born at the beginning and/or end of a generation) often can, with greater facility, bridge the generational gap 16. However, mentoring in and of itself is not sufficient to totally capture the attention of Generation Y. In the educational process, traditional "chalk talk" is also less likely to attract this generation's attention. Unlike Generation X, which was thrust into the digital revolution, Generation Y has evolved with it. Its learning style requires a very different educational environment, one that is rich in both visual and audio stimulation. The traditional "sage on the stage" teaching model that provides knowledge by lecture and PowerPoint slides no longer suffices, nor does the contrasting medical education model of the Socratic Method, whereby the resident is challenged to respond to questioning in the presence of his/her peer group (ie, "pimping") 17. These 2 traditional methods, which emphasize memorization, recall, and repetition with the teacher acting as the all-knowing seer, are not relevant to Generation Y's learning style. This generation is quickly bored with the traditional lecture format. Instead, the alternative of class discussions offers a potentially more productive learning environment for this socially collaborative and inquisitive generation. Instead of a hierarchal paradigm of education, they require a learner-centered model that focuses on acquiring knowledge by an active discovery method. Although they still view the teacher as an expert, their respect for him/her in turn can be affected by how computer literate the teacher appears to be. Although this generation desires immediate feedback, it resents the public censor that may inadvertently occur with use of the Socratic Method. Traditional book-based learning is linear, with knowledge sequentially acquired from the beginning to the end of the text. However, Generation Y processes information in a more random, interactive, and often nonsequential manner via the use of digital-based resources, including, among others, blogs and Web sites, as well as social media. Moving from one of these educational resources to another, as well as back and forth in their online search, they are able to build a personalized information base. The educator's role in this contemporary learning process is altered from that of a provider of information to one of a facilitator, offering guidance regarding educational resources and the digital tools necessary to access this knowledge 18. The educational challenge for PM&R is to capitalize on the strengths of this generation. The focus should be on building their knowledge base with content that requires critical inquiry. In this process, the teaching faculty must make every effort to meet Generation Y halfway and to consciously or otherwise stop resisting change. After all, if we continue to teach as we have done before, we will always return to where we started. Although the intellectual content of the curriculum may remain the same, the technology required to master it has evolved over time. Having little tolerance for delay, Generation Y expects immediate access and response. As multitaskers, always on the move, they remain connected either by smartphones or electronic tablets. In the "real time" of the workplace, instant messaging has supplanted the relatively slow e-mail, phone communication, and/or traditional mail. Digital communication occurs in 3 basic forms: as one-on-one e-mail and instant message; as one-to-many news groups, message boards, and social media, such as Facebook and Twitter; and as many-to-many Web casts, Wikis, and chat rooms. When residents are off site, as in multiple hospital systems, Internet-enabled conferencing in real time can avoid the necessity of driving in heavy traffic from one site to another. The "face-to-face" feature built into the iPhone is presently enabling this option. Video recordings can also be "time shifted" to meet the learning needs of the busy resident's daily work schedule 19. Generation Y's continued connection to the computer has not been without an intellectual penalty. Neuropsychologists have theorized that this technology is, in fact, reprogramming the very organ of its genesis—the human brain. This digital "rewiring," although fostering faster cognitive responses and an increased facility to sort out extraneous information, is also reducing the ability to recall information. As a consequence, Generation Y has demonstrated both increased distractibility and a shortened attention span, as well as poor writing skills 20. Freely available online professional information has also had the unintended consequence of devaluating the printed word. The hardcover textbook, as well as the hospital library, is increasingly being supplanted by online content. As digital gypsies, Generation Yers are rarely out of touch unless they decide to be! Quality time with friends and family is judiciously guarded as smartphones are, in a timely manner, switched off in an effort to meet family obligations. This need for more personal time is underscored by societal concerns about marital instability, which has been increasing with each successive generation 21. Generations Y's self-identity is different from that of their physician predecessors. They see their connection to work as only a part of their personal identity, and not necessarily the most important part! Previous generations of physicians' professional attitude was one of a "calling," often a 24/7 investment of time in their professional life. As a consequence, in many instances they have come to resent Generation Y's need for off-time, considering it an expression of disloyalty to the workplace and to the attending staff, as well as an apparent sign of laziness 22. However, restricted work hours, attributable to the Libby Zion incident 23, have led to a gradual acceptance and an increased tolerance for this newer work paradigm. Unfortunately, this change in work style has had the inadvertent effect of reducing work-related departmental and after-hour socializing. As a consequence, it is increasingly difficult to establish an extra-hours meeting, because the residents' early and/or late commitments to family often take precedence. By example, Generation Y's lifestyle has also had a significant impact on its generational predecessors as they re-evaluate their own work/family priorities 24. Alternatively, working lunches can be productive, especially when brief and preceded by a rigidly crafted schedule, encouraging feedback, goal-setting, and team esprit de corps. As an initial "icebreaker," the Socratic method of questioning is useful, because it does encourage earlier participation, but it should also be conducted courteously. Questions that have the inadvertent appearance of being mean and/or degrading should be avoided so as not to publicly embarrass the responder. This can be accomplished by respecting the audience's seniority, that is, the "resident pecking order," choosing the junior over the senior resident for questioning, and if necessary, immediately supplying answers when uncertainty arises in the respondent. If concerns exist as to the responder's depth of knowledge or lack thereof, critique should be conducted privately. Reserving time for childrearing requires creative strategies, especially in dual-career families. All too often this need for personal time does conflict with their professional responsibilities. Difficulty resolving these 2 issues, that is, a full-time commitment to parenting as opposed to that of a physician who is simultaneously a provider of medical services, as well as a student, can lead to burnout. This dilemma may be further exacerbated by a resident's spouse, who is also conflicted by the necessity of accommodating family and career responsibilities 25. Among a number of other factors contributing to increased emotional stress may be dissatisfaction with their chosen specialty, imbalance in their work/personal time, and both physical and emotional fatigue, all compounded by increasing financial strain. Each issue, individually and together, may contribute to an erosion of the resident's professional idealism. With increasing emotional exhaustion, clinical depression may quickly follow. Both women and minorities appear to be the most vulnerable in this regard, with a rate of burnout in these 2 groups estimated to be greater than 40% 26. Depression is certainly a risk factor for suicidal ideation. The risk of suicide among young physicians is twice that of the general population, that is, 2.5%-5.7% in women physicians and 1.1%-3.4% in male physicians 27. A sudden change in social and/or professional behavior of a resident should call attention to the fact that they may be struggling with the reality of clinical depression. A well-established mentoring relationship may serve as a "tripwire," calling attention to this problem at an earlier time. However, personal, professional, and legal, prohibitions must be respected in calling attention to this problem. Even recognizing a problem of depression may not be sufficient to avoid its most severe consequence. In the gene

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