IAMSE Spring 2024 Webcast Audio Series – Week 3 Highlights

Presenter: Shannon Jimenez, DO, MPE, FACOFP Dean, Arkansas College of Osteopathic Medicine
Kara Sawarynski, PhD. Sarah Lerchenfeldt, PharmD, Tracey A.H. Taylor, PhD, and Stefanie Attardi, PhD. Department of Foundational Medical Studies William Beaumont School of Medicine Oakland University

[The following blog was generated by Susan Ely and Doug McKell]

Communication Differences among Generations

The Learning Objectives for the second Spring 2024 IAMSE Webinar series on Teaching and Learning in Medical and Health Professions Education includes the following: First, discern the generational differences and how they affect communication. Second, recognize the history and sociology behind differences among generations. Third, remember the dominant communication preferences of each generational group. Fourth, develop strategies to design and deliver health professions education to meet the needs of Gen Z learners.

Dr. Jimenez began her presentation by outlining the primary communication preferences of each of the five identified generation age groups, specifically Traditional, those born before 1945, Baby Boomers born 1945-1965, Generation X (Xers, or Gen X) born 1965 -1980,  Generation Y (Gen Y or Millennials) born 1980 – 1996, and Generation Z born 1996 – 2012. She focused on the critical points of difference and emphasized the communication choices of each group.

Dr. Jimenez described the traits of the Traditional Generation in the following ways. They are known as “The Silent Generation” for being more formal, stoic, risk-averse, and for prioritizing duty. They let their actions speak louder than words and expect others to understand their behavior. For this reason, they make decisions based on what worked in the past, focusing on values,  respect, stability, order, and practicality. When speaking to the Traditional Generation, use formal communication, i.e., letters or emails. They can be counted on to respond and will be direct, polite, and respectful, using thank-you notes and personal expressions to convey their feelings and interests.

Dr. Jimenez emphasized that Baby Boomers respect authority but only sometimes trust it. Many are very accepting of diversity, and they tend to be optimistic. They also tend to be more politically liberal, conflict-avoidant, and relationship-oriented.  Baby Boomers value directness, respect, and optimism.  Boomers value hard work and innovation, prioritizing relationships and questioning the status quo. When speaking to Boomers, be diplomatic and avoid confrontation, as confrontation can be interpreted as disrespect. Speak to their sense of righteousness and their contributions to the greater good.

The critical issue for Gen X is that they grew up in a period of financial insecurity, with both parents working and limited wage mobility, leading them to question authority and walk away from the workaholic lifestyle of the previous generation. According to Dr. Jimenez, they value a balance between work and life. They tend to be fiercely independent, entrepreneurial, pragmatic, and creative. They value actions more than words, although slightly less so than the baby boomers, and they value accomplishments more than money. When communicating with Gen X, realize that their words can sound harsh. They are less formal and more to the point. They prefer in-person communication or a phone call. They need to be reminded to give and take feedback and use empathy.

Because of the significant digital communication experience Millennials have grown up with, they tend to have a slightly shorter attention span. They are very used to things being clear and well-categorized, and they much prefer it that way. Millennials tend to expect a rapid return of information. For example, Millennials will send a presentation for review to educators via email, and they expect at least an acknowledgment of the receipt. They prefer digital communication rather than phone calls. Millennials also tend to be less formal in communication and seek connectivity with coworkers and bosses outside of work. By and large, they are confident and optimistic idealists for whom words mean more than actions. They are good at teamwork but have correspondingly high expectations from authority figures. Overall, they have a shorter attention span and place exceptional value on achieving a work-life balance.

The Generation Z (Gen Z) cohort values hard work, initiative, and contributions to the greater good. Dr. Jimenez pointed out that Gen Z members are known as technological idealists and social justice warriors. They value meaning and are motivated to contribute positively to the next generation; they are the most racially and ethnically diverse generation in history. They embrace diversity and expect their leaders and institutions to do the same. They perceive that the world is smaller because of technology, and they use technology for communication more than any other generation. A key trait for Gen Z individuals is that while they are Digital Natives, their trust must be earned. As social justice warriors, they want to be part of the greater good and, when doing so, value effectiveness over convenience. Dr. Jimenez noted that Gen Z members prefer face-to-face communication, expect digital communication from school/teachers, and require frequent feedback or check-ins to see how they are doing.

Exploring Best Practices in Health Profession Education for Gen Z Students

Dr. Sawarynski began her presentation by reminding everyone that generation classifications are broad categories that are not scientifically defined. They can lead to stereotyping and oversimplification, and discussions too often focus on differences instead of similarities. Despite these cautions, she and her colleagues strongly believe that reflecting on the experiences and perspectives our students bring to their education can help us understand how our student populations have changed over time and improve the medical education environment for everyone. Data from the AAMC matriculating student questionnaire from 2016 to 2023 indicate that age group cohort breakdowns haven’t changed over time. The average age of the entering medical student is still 23 years old. Although their average age hasn’t changed, the generation that they belong to has dramatically changed. Most current first-year student classes belong to the Gen Z generation.

Dr. Sawarynski continued by pointing out that based on several national data sets, Gen Z students have had a drastically different set of social experiences than many previous generations. For example, there has been a steep decline in the percentage of students obtaining their driver’s license by the time they’re in 12th grade, and in alcohol use, part-time work, having sex, dating, and a whole range of social experiences. Because significant technological shifts drive many generational cut-off points at the beginning of new generations, monumental advances in communication patterns have affected how we meet, connect, and communicate. Today’s online connections for Gen Z students differ significantly from previous generations. Dr. Sawarynski emphasized that Gen Z individuals are comfortable reaching out and communicating with friends, peers, and people they may only know through online connections, including affinity groups.  This interaction with all kinds of social media groups can be drastically different from the communication experiences the medical school faculty had at the same age. In addition, Internet technology allows constant communication with peers throughout the day. The result is that students can participate in parallel dialogues even while in the classroom. The result is that those present need to think about what is happening in person versus what is potentially happening simultaneously via electronic communication.

Dr. Lerchenfeldt began by highlighting a concerning trend in mental health among young people. She presented national data reporting that the prevalence of critical-level depression among teens and young adults has more than doubled from 2011 to 2021. In only 16 years, the rate of clinical depression has doubled in US teens and young adults. By 2021, nearly 30% of teen girls and 12% of teen boys were reported to suffer from clinical-level depression. She focused on Generation Z, individuals born from the late 1990s to the early 2000s times, who are particularly facing serious mental illness, especially the oldest members of Gen Z, those aged 18 to 25. They exhibit a strikingly high prevalence of mental health illness at 11.4%, about twice as high as the general population.  A 2018 meta-analysis published in 2018 synthesized data from 69 studies with over 45,000 medical students. It reported the global prevalence of anxiety in students was 33%, three times higher than in the general population. Some of the factors contributing to this high percentage included the intense academic workload, sleep deprivation, financial burdens, and exposure to patient deaths. The same study reported medical student depression at 30%  and burnout at 37%.

Dr. Lerchenfeldt continued by discussing communicating with Gen Z students who value equality, social justice, and transparency. As a result, they want fairness and inclusivity from their education, and they have a greater awareness of mental health. That might mean expanded mental health services, on-demand counseling, and curriculum integration, including wellness and self-care literacy.  She reminded everyone that Gen Z individuals value autonomy and want to be involved in decision-making with clear communication and personalized collaboration.  Gen Z students prefer a flexible, self-paced environment that integrates technology and offers opportunities for collaboration. She asked, “How can we address this as educators?” She discussed using backward design to focus on desired learning outcomes before choosing our instructional method. She also invoked the need for transparency and explanation of selected instructional strategies and learning goals so students can better understand and engage with the educational material. This brings up a couple of additional questions. What does engagement in the hybrid or asynchronous learning environment look like? Does it involve flexibility and modification of course materials? Does it include in-person and online interactions like discussions and digital forums? In an asynchronous environment, does it allow students to use content they believe is essential to understand these preferences? Students expect a robust support system and medical education. Educators should consider more highly developed digital literacy for their Gen Z communication preferences, engaging them with higher-quality visual and interactive content.

Dr. Lerchenfeldt continued the webinar by reminding us that the end goal is to develop health professionals who can be successful in intergenerational clinics. Educators could think about building useful toolbox-type things within the curriculum, being very intentional about when, why, and how to be transparent about in-person events. Feedback on skills should be offered, keeping in mind what is relevant to the practice of future physicians. For example, can we deliberately and transparently incorporate these ideas and practices into our curriculum in new places not previously considered? Integration of role models for interpersonal and team skills across generations also needs consideration.

All three speakers emphasized the need for educators to support students’ mental health given the following realities:

Many students will spend more time with educators than any other university employee.

Mental health issues may appear on the surface as professionalism issues (e.g., missed deadlines, absenteeism, lack of care with instructions)

While faculty members must work within their qualifications and roles, all educators canseek to understand signs of distress in students, be aware of campus mental health resources and keep their materials readily available (e.g., brochures, QR codes), refer students to the appropriate personnel (e.g., counseling center, dean of students) be aware of campus emergency contacts and reporting procedures, and model self-care, as applicable.

The webinar concluded with two final thoughts from the speakers. First, continue to seek and embrace change. Consider whether or not educators are adapting at the same rate as the available technology our students already use. Explore opportunities to empower students to teach faculty members. Ask students for their perspective on how new tools, ideas,  resources, etc., meet their needs. The speakers encouraged involving student representatives, soliciting their concerns and ideas as an acknowledgment of the vast differences between their experiences and ours. Second, work to be transparent whenever possible. Sound pedagogical reasons for doing things a certain way may be present, but students may have different understandings. Being transparent can go a long way to help bridge those gaps.