Medical Education for the “Echo Boomer” Generation Medical Education Grand Rounds: Friday, October 31, 2008

1. Medical Education for the “Echo Boomer” GenerationMedical 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 University, Boca Raton, FL

2. Who Are the Echo Boomers? • A “generational cohort,” the “echo boomers,” were born between 1981 and 2000. They are <27 years old. • 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. See Kruse, “Buckle Up; Generation Y is Here” at http://www.clomedia.com/content/templates/clo_col_elearning.asp?articleid=410&zoneid=46

3. Four Generations: Our workforce today arguably consists of four major generations: • 1. Veterans/Matures: 1922-1943 (>62) • 2. Boomers: 1943-1960 (42-62) • 3. Gen X’ers: 1960-1980 (27-42) • 4. Gen Y’ers/Nexters/Millennials/Echo Boomers: 1980-2000 (<27)

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

5. GenXers 1960-1980 CORE VALUES • Diversity • Thinking Globally • Survival • Self reliance

6. GenXers 1960-1980 SEMINAL EVENTS • 1970 Women’s Liberation Protests • 1973 Watergate Scandal • 1979 Three mile Island Nuclear Meltdown • Massive Corporate Layoffs • 1987 Stock Market Plummets • 1991 Operation Desert Storm

7. GenXers 1960-1980 HEROES • None (no one famous but you can inspire Xer loyalty)

8. GenXers 1960-1980 ASSETS ON THE JOB • Adaptable • Independent • Unintimidated by Authority • Creative

9. GenXers 1960-1980 LIABILITIES • Impatient • Poor People Skills • Inexperienced • Cynical

10. Nexters/Millenials/Y’ers/Echo Boomers 1980-2000 CURRENT CORE VALUES • Optimism • Civil Duty • Confidence • Achievement • Sociability • Morality • Street Smarts • Diversity

11. Nexters/Millenials/Echo Boomers 1980-2000 SEMINAL EVENTS/TRENDS • Violence: Oklahoma City Bombing • Clinton/Lewinsky • Columbine High School Massacre • Child Focus • Technology • Stress

12. Nexters/Millenials/Echo Boomers 1980-2000 HEROES • Michael Jordan • Princess Diana • Mother Teresa • Bill Gates • Tiger Woods • Christopher Reeve

13. Nexters/Millenials/Echo Boomers 1980-2000 ASSETS ON THE JOB • Collective Action/Teamwork • Optimism • Tenacity • Multitasking Capabilities • Technological Savvy

14. Nexters/Millenials/Echo Boomers 1980-2000 LIABILITIES • Need for supervision and structure • Inexperienced particularly when handling difficult people issues

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

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

17. 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?

18. Yes, …So How do We Teach Them?

19. Medical Education and the Echo Boomers: A Relevant Quote • “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

20. 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. 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

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

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

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

24. 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

25. Learning Theories and the Echo Boomer • Russell Ackoff, Professor Emeritus of the Wharton School talks about a “spectrum of learning:” • DataInformationKnowledge UnderstandingWisdom • 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. See his book Introduction to Operations Research, co-authored with C. West Churchman

26. Learning Theories and the Echo Boomer • 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 • Multiple ways of viewing reality imply multiple ways of learning

27. Learning Theories and the Echo Boomer • 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): *[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.]

28. Learning Theories and the Echo Boomer

29. Learning Theories and the Echo Boomer • What if medical schools shift to a true “learning orientation,” re-examine the traditional “performance orientation,” and develop a curriculum that is intrinsically motivating?

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

31. Learning Theories and the Echo Boomer Today’s typical medical school curriculum: very simplified* • Preclinical curriculum/basic sciences • Clinical curriculum • Electives • Assessment of medical students *See AAMC’s Curriculum Directory at http://services.aamc.org/currdir/about.cfm

32. Medical School Teaching Methods • Traditional lectures • Small-group discussion • Self-instruction • Laboratories • Case studies • Computer assisted instruction • Clinical venues *See AAMC’s Curriculum Directory at http://services.aamc.org/currdir/about.cfm

33. Future Trends Will Also Influence Medical Education Courtesy of SG2. See www.sg2.com

34. Future Trends that will Influence Medical Education Courtesy of SG2. See www.sg2.com

35. Future Trends that will Influence Medical Education Courtesy of SG2. See www.sg2.com

36. Future Trends that will Influence Medical Education Courtesy of SG2. See www.sg2.com

37. Future Trends that will Influence Medical Education Courtesy of SG2. See www.sg2.com

38. Future Trends that will Influence Medical Education Courtesy of SG2. See www.sg2.com

39. Future Trends that will Influence Medical Education ** **Implantable cardioverter defibrillators (ICDs) and biventricular pacemakers for cardiac resynchronization therapy (CRT) Courtesy of SG2. See www.sg2.com

40. Future Trends that will Influence Medical Education Courtesy of SG2. See www.sg2.com

41. 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?

42. The Generation Y Doctor:Beyond Knowledge • Remember Ackoff’s model? • 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

43. 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?

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

45. The Generation Y Doctor:Beyond Knowledge • Pedagogical techniques for the Gen Y’er: • Small group discussions • Large group interactive sessions • Problem-based learned • Team-based learning • 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”)

46. Teaching Techniques That I Use at My Current School • The following are techniques, learned the “hard way,” that work at UMMSM@FAU • 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: “Do I really have to buy the textbook.”

47. Educating the Gen Y Doctor: Ten Tips: Introduce Yourself • “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 • 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

48. Educating the Gen Y Doctor: Ten Tips: Keep it Real • Tell them the goals/objectives • Make it relevant • Provide a personal incentive that will save them time in studying, etc • Utilize real world examples • 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

49. Educating the Gen Y Doctor: Ten Tips: Be Visual • Students retain only10% of written materials, but 30% of what they see [Miller] • Text heavy slides are disadvantageous; images rule • 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

50. Educating the Gen Y Doctor: Ten Tips: Utilize Humor • Irony and self-deprecating humor works well • 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