Explore This IssueJanuary 2015
As each new generation of physicians comes along, changes in the educational experience follow. The younger groups come in with different expectations, learning needs, and styles. And the newest group also has to be trained and educated to work in a medical system undergoing seismic changes.
“The ‘Millennials,’ born between 1982 and the present, are generally characterized as being more realistic and more accepting of authority,” said Jesus Medina, MD, professor of otolaryngology at the University of Oklahoma in Oklahoma City. “They had a childhood full of trophies and adulation that makes them feel special and are prone to demand more attention. We as a faculty have to realize that and make changes to medical education to meet the reality.”
Changes in Medical School Structure
One change has been in the structure of medical school itself. Unlike preceding generations, younger physicians-to-be have grown up experiencing many of their most productive interactions in smaller groups online in convenient text and video formats. These students are likely to find the traditional professor-lecturing-the-class model less useful than Baby Boomer or Generation-X students might.
“When I was looking for a medical school, I was attracted to those schools that had a case-based approach,” said Tammer Ghaly, a fourth year medical student at SUNY Upstate Medical University in Syracuse, N.Y. “You break up what needs to be known among different students who go home, learn their part and present it to the entire group. Essentially, they teach each other, with a faculty member making sure everything important is covered.”
Millennials also prefer to have more options in both the timing and method of their courses. The rise of the Internet allows them to listen to podcasts instead of attend lectures, and, rather than wading through a 5,000-page textbook, they learn best when given guidance on finding the resources they need.
Students are coming to us with different experiences and abilities than in the past. By drawing on these experiences, I find that such students are much more adventurous and willing to think outside the box.
—Carrie L. Francis, MD
“The expectation of the current group of students is that they will be able to learn at their own pace with direction and multiple reference options,” said Carrie L. Francis, MD, assistant professor in the department of otolaryngology, head and neck surgery at the University of Kansas Medical Center in Kansas City. “Most of our students, for instance, listen to podcast lectures at 1.5 to two times normal speed to use their time more efficiently.”
Ghaly echoes that sentiment, noting, “Some like self-education, while others prefer a lecture style. Everyone has a different way of learning, and I think current medical school students want to be able to customize their own programs.”
There has been a push to get more hands-on clinical training earlier. Some schools offer preceptorships and other clinical rotations in the first year. There also is an increase in task labs and simulators that engage learners and let them achieve their objectives in a controlled environment before patient interactions. Expansion of student-run clinics gives new students opportunities to see patients, go through the differential diagnosis process, and formulate care plans under the supervision of faculty.
Rise of Nontraditional Students
Some of the change in how medicine is being taught is driven by another major difference from previous generations: There are more nontraditional students coming into medical schools.
This change can be seen in two areas. First, more Millennials are entering medical school later in life. Second, these students have a more eclectic mix of undergraduate degrees.
“Students are coming to us with different experiences and abilities than in the past,” noted Dr. Francis, who also serves on the school of medicine’s admission committee. “Not all applicants have a biology or chemistry degree. We have admitted students leaving an established career in engineering and even some graduating from theater schools. By drawing on these previous experiences, I find that such students are much more adventurous and willing to think outside the box.”
Schools have seen an influx of applicants who are coming to them with life experiences that were not seen as often in the students who came before. These students have done more than simply shadow physicians in their hometowns—their accomplishments include completing medical mission trips or volunteering in clinics. “The foundation pieces of good medical college admission test scores, high undergraduate grades, good interviews, and letters of recommendation remain important,” said Dr. Francis. “But we are also looking for students who can add to the diversity of an entering medical school class. Such characteristics may include significant life experiences with individuals from backgrounds different from their own, experiences in research or other creative work, significant multilingual abilities, or success in overcoming adversity. Our students pull from those experiences, bring unique viewpoints to the table, and put their individual talents to use in medicine.”
Residency Will Be Different
There have also been major changes in the education of residents; however, in this case, instead of generational concerns, the biggest differences are related to the effects of fatigue on the ability to provide competent care and liability.
“For instance, work hour limits mean that residents can only put in 80 hours a week and have to have specific rest times,” said Dr. Medina. “That is really a significant change from even 10 or 15 years ago.”
While there are valid reasons for these changes, there are also concerns that residents are not getting in the hours they need to reach competency in some areas. The irony, noted Dr. Medina, is that these requirements are not totally in sync with the reality of practice, where there are no such restrictions. He noted that most practitioners of head and neck surgery probably work more than 80 hours in a week.
“Despite the work restrictions, we still have to impart an increasingly large and complex body of knowledge to our residents,” noted Giancarlo Zuliani, MD, the residents program director at the Wayne State University School of Medicine in Detroit. “We still have to make sure our residents know and fully grasp the information that is important to our specialty.” He does say that this concern is somewhat offset by the Millennial’s ability to multitask.
There is a dichotomy in the methods residents use to learn. Unlike earlier generations, Millennials do better when they are given specific goals to achieve; however, they also want the ability to meet those requirements in their own way.
“It is an odd dynamic,” said Dr. Zuliani. “Millennials need constant stimulation and constant direction. Just the amount of information is too much to tackle all at once, so they have had to become very active in their own education. We almost have to customize each residency, unlike the 50s and 60s, where they were told what they needed to know to get out and into practice.”
There is also a need for a more active feedback component. In earlier generations, it wasn’t unusual to get an evaluation every three to six months. “Millennials want constant feedback, both negative and positive,” said Dr. Zuliani. “They want to know immediately what they need to do to improve instead of waiting until their memories of the event have faded.”
The current residents are also more interested in balancing personal and professional lives. Not sacrificing family to the profession is important. “With two-earner families, the dynamics have had to change,” said David S. Cohen, MD, a PGY-4 resident at Wayne State. “If you want to take your kids to soccer, then you can’t be on call every day. We see the strain that medicine can often put on a family and want to maintain a good balance.”
Millennials’ view of the faculty is also changing rapidly. In the past, the relationship was more formal. “Residents value mentorship more than prior generations,” said Dr. Cohen. “It is a more interactive type of relationship. Less of a father/son and more of an older sibling/younger sibling dynamic. Someone who has more street sense and more experience, who you can go to for advice.”
Medical education at all levels has continually evolved to meet the needs of both the profession and the student/resident. This ability to change with the times has been one of its strengths.
Kurt Ullman is a freelance medical writer based in Indiana.