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Residency Corner

Keys To Bridging The Generation Gap With Residents

Should intergenerational differences play a role when determining how to provide the best possible educational experience for residents? A panel of residency directors share their observations and experiences in teaching and working with younger generations of residents.

Q:

Do you find any significant differences in selecting or teaching millennial and Generation Z residents as opposed to previous generations? If so, please share any notable changes or challenges.

A:

Patrick S. Agnew, DPM, FACFAS notes he definitely sees differences from residency class to residency class with some reproducibility that suggests patterns that may possibly be attributable to birth generation. However, Dr. Agnew emphasizes that each class has strengths and opportunities for improvement, and cautions against stereotyping.  

“I would say that more recent residency classes seem to be more interested in hands-on involvement in program administration and procedure,” notes Dr. Agnew. “Although there are specific limitations in the amount of administrative tasks residents can be a part of, I can only think that hands-on participation will help future residents and residency programs in the future.”

Dr. Agnew acknowledges that in some instances, a more seasoned dictatorial -style director might bristle at questions regarding the execution of their program.  

“But the opportunity to examine one’s own mannerisms through another fresh set of eyes can only be helpful to all parties involved,” says Dr. Agnew.

Zeeshan S. Husain, DPM, FACFAS, FASPS finds differences between generations with respect to their motivation and desire to excel. Specifically, he notes a trend that Generation Z residents need more explicit direction than millennials, including explanations as to why things are done in a particular way. 

“As part of Generation X who went through residency training in 2000, there was an expectation to follow and do what I was told without question,” explains Dr. Husain. “I had to figure out ‘why’ on my own or engage attendings for further explanation. This often did not yield a satisfactory answer as they merely repeated what they were trained to do. As an instructor now, I find myself verbalizing certain surgical techniques, clinical rationale and my thought process in different ways so the residents understand and can adopt such principles. As part of this process, I have to continuously reassess my rationale and find myself open to differing opinions.”

Dr. Husain personally finds that the personalities in the Generation Z and millennial groups both seem to seek approval and need positive reinforcement. Building healthy relationships with the residents outside of the residency setting has become part of the team building process to make them feel welcome and comfortable in asking questions. When providing reviews, Dr. Husain says emphasizing the strengths needs to be a priority before giving constructive criticism.

Kimberly Hurley, DPM, FACFAS agrees that both millennials and Generation Z learn differently than previous generations of residents. She, too, notices that the authoritative, unquestioned teaching that was more acceptable to Baby Boomers and Generation X does not resonate with younger learners.

“Millennials and Gen Z do not want to follow directions just for the sake of following directions,” shares Dr. Hurley. “They expect decisions and actions to be justified, and respond positively when their instructors provide the rationale behind their decisions.”

Dr. Hurley also relates that she feels these learners prefer a more relaxed learning environment. 

David Bernstein, DPM, FACFAS states that he sees no significant difference in teaching or communication with Generation Z or millenials throughout his residency program.

“Our residents are mature enough that they realize they must be on the same level of teaching and communication as our attendings,” maintains Dr. Bernstein. “COVID-19, has put more teaching online which all students, residents and attendings are capable of taking part in.”

Q:

What unique characteristics do you feel residents of these younger generations bring to patient care? Are they quicker or slower to learn new ideas and techniques? Are they more or less motivated to learn and work harder?

A:

Dr. Bernstein believes there is no difference in the approach to patient care within these younger generations, citing individual resident maturity contributing to a seamless learning experience and adaptation to new procedures and techniques. He does note these residents may be more likely to listen carefully and express sensitivity to patient concerns.

Dr. Agnew also does not feel residents classified as millenials or Generation Z acquire skills at a differing speed from their predecessors. He does notice that electronic medical record management seems to be easier and easier for them over time in comparison to residency classes in previous years.

He cannot say, however that interaction with patients has improved at the same pace.

”It may be that patients of a certain age are more inclined to require medical intervention and be hospitalized, and even though residents have always been around the same age, the differences between generations of patients such as baby boomers and more recent generations of residents serving as providers seem, from my perspective, to be more stark,” notes Dr. Agnew. “These differences include expectations from each other as well as society and health-care systems at large.”

Personal relationships and empathy are part of what this current generation of learners thrive on, says Dr. Hurley. In her experience, Dr. Hurley says residents today typically learn new ideas and techniques quickly, and are very research- and outcomes-driven. Additionally, she notes that these generations tend to seek more than one way of doing things, which she feels is a deviation from previous classes of residents.

“Generation Z and millennials provide a more personalized patient treatment plan and are patient advocates in comparison to prior generations who have a more hard-line approach to what is best for the patient regardless of the patient's concerns,” says Dr. Husain. 

He agrees that their adoption of new techniques and technologies is swift, and that they are less likely to use older methods simply due to tradition without examining more current modalities as well.

“Their motivation is no different than older generations in that they want to learn and get better, but they are motivated in areas that interest them rather than what they are told to improve on,” explains Dr. Husain.

Q:

If you feel there are notable differences, can you share a unique interaction or experience you have had with this generation of residents that others involved in medical education may benefit from?

A:

Dr. Hurley relates an experience where, after a Grand Rounds lecture at a hospital outside her health system, several students reached out via e-mail to ask questions. Many even asked her to share the presentation so they could review the relevant literature within it.

“I was surprised at their enthusiasm to learn beyond the allotted time,” shares Dr. Hurley. “I was also surprised that the students, who did not know me, felt comfortable enough to contact me directly with so many questions. In the hierarchy of the hospital where I trained, only the chief residents felt comfortable reaching out to an attending and it went down the chain from there.”

As he shared before, due to residents being unlikely to blindly follow instructions, Dr. Husain says that he continually reevaluates his treatment methods and rationale in order to be able to convey them satisfactorily to his residents. Although he adds that this leads to lengthy discussions and slows down their initial learning curve, Dr. Husain believes it eventually results in a better and deeper understanding of crucial topics.

“I have always maintained that I benefit more from teaching in graduate medical education then the residents do,” says Dr. Agnew. “One never fully understands something until one tries to explain it to someone else. The process of learning how to teach reinforces this knowledge.”
 
Dr. Agnew recalls his experience as a learner and applies this to the newer generations of residents he teaches.

“James Ganley DPM was prone to say that if the student doesn’t surpass the teacher, the teacher has failed,” maintains Dr. Agnew. “I’m proud to say that in individual ways, all of our residents have surpassed our faculty, including me in particular.”

Dr. Husain continues to say that these younger generations place great importance in a sense of purpose and personal well-being.

“Working for a living is not as much of a priority as keeping a balanced professional and personal life. Whereas past generations would stay past typical working hours to accomplish outstanding tasks, these groups are more inclined to work within typical work hours,” notes Dr. Husain.

Dr. Bernstein says one observation of note is that current generations of residents constantly communicate with each other during the course of the day to function like a well-oiled machine, which may result in better teamwork.

Q:

How does podiatry as a profession need to engage these generations of students and residents in a different or meaningful way? Is there advice from previous generations that current residents may find beneficial?

A:

Dr. Husain shares that during his training, fear and criticism motivated him to improve and excel, but that this does not work with younger generations. In fact, he explains this is often counterproductive and leads to barriers in learning and developing a good rapport. Instead, Dr. Husain finds that winning the trust of residents with positive reinforcement and constructive criticism is far more effective. He also relates that these residents are more visually oriented and may have more success when given some latitude to find their own comfort level of doing things as opposed to being forced into the way the instructor would do it. Additionally, in his experience. Dr. Husain feels that straightforward lectures are less effective than videos and hands-on workshops.

Dr. Bernstein maintains that the profession does not necessarily have to approach these younger learners any differently because each generation has to be able to meet, understand and respect each other.

“I think too much has been said about these differences between the generations than really exists,” maintains Dr. Bernstein.

Dr. Agnew feels that teaching with methods that appeal to the greater good are most effective for him.

“The teaching and practice of medicine in general is in many ways like training and fighting a war. Comrades in arms fight side by side against a hated enemy in often dangerous circumstances. This is certainly true for anybody involved in medicine today, in particular,” points out Dr. Agnew. “The pandemic is a horrible tragedy for the world. The health-care workers that survive will do so with experience that cannot be taught or simulated. There is no substitute for live fire experience. This generation of trainees will emerge stronger, wiser and with the perspective that can only be gained through conflict. They will surpass us and make us proud.”

Dr. Hurley concludes by encouraging the profession to acknowledge these differences carefully to improve upon educational efforts.

“Medical education is traditionally based on a hierarchy system. Our profession needs to recognize that often this hospital-based training hierarchy forces learners to blindly follow their superiors’ instruction without clear rationale,” suggests Dr. Hurley. “This can result in poor communication and fragmented supervision.”

Due to millennials and Generation Z thriving on interpersonal relationships and seeking justification for decisions, Dr. Hurley feels podiatry should attempt to leave the traditional model of hierarchical learning behind and create an educational environment based on an apprenticeship model that focuses on mentoring, barrier-less communication and constant observation.

Dr. Agnew is the Director of the Podiatric Residency Program at Eastern Virginia Medical School in Norfolk, Va. He is a Fellow of the American College of Foot and Ankle Surgeons, and the American College of Foot and Ankle Pediatrics.

Dr. Hurley is the Director of the Podiatric Residency Program at Cooper University Hospital in Camden, NJ. She is a Fellow of the American College of Foot and Ankle Surgeons, and is an Instructor of Orthopaedic Surgery at Cooper Medical School of Rowan University in Camden, N.J.

Dr. Husain is the Director of the Podiatric Residency Program at McLaren Oakland Hospital in Pontiac, Mich. He is a Fellow of the American College of Foot and Ankle Surgeons, and the American Society of Podiatric Surgeons.

Dr. Bernstein is the Director of the Podiatric Residency Program at Bryn Mawr Hospital in Bryn Mawr, Pa. He is a Fellow of the American College of Foot and Ankle Surgeons.

Residency Corner
Clinical Editor: David Bernstein, DPM, FACFAS
Panelists: Patrick S. Agnew, DPM, FACFAS, Kimberly Hurley, DPM, FACFAS and Zeeshan S. Husain, DPM, FACFAS, FASPS
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