Generational differences in communication and translation to medical education

Shannon Ramsey Jimenez, DO, FACOFP | Srj033@shsu.edu

Disclosures and Funding: The authors received no financial support related to this submission and have no financial affiliations or conflict of interest related to this article to disclose.

INTRODUCTION

Five generations are currently living together on the planet, and each generation is of the age to have formed their own opinions and expectations. The different generations include: the traditional generation (born before 1945), baby boomers (born between 1945 and 1965), generation X (born between 1965 and 1980), generation Y, also known as Millennials (born between 1980 and 2000) and generation Z (born between 2000 and the 2010s).1 Each generation has special characteristics brought out by the times in which they have lived. These characteristics in turn affected the way they communicate in both reception and expression of information. The following article looks at key differences between the generations and discusses their application to medical education. Both older generations, as well as younger generations, will be discussed, as many educators will fall into the older generations. For educators to better understand medical students, educators need to first understand themselves. Everyone views the world through the lens of their own personal histories. Being mindful of these generalities can help us communicate more effectively. For each generation, there will be a brief synopsis of characteristics followed by communication suggestions for preceptors and students. The purpose of this report is to improve preceptor-learner communication. However, the knowledge shared can carry over into many other coaching or mentoring situations.

RESULTS AND DISCUSSION

The traditional generation

The traditional generation, those born before 1945, was shaped by the Great Depression and World War II, among other events.  They have been described as “emotionally conservative,” which is one reason they are also called the “Silent Generation.”2 They tend to be disciplined, more formal and have a keen sense of duty. Traditionals like to follow the chain of command and prefer to make decisions based on what worked in the past, but they still seek out technological advances. They value respect, stability, privacy, integrity, order, consistency, effective communication skills and dues payment. Traditionals are loyal workers who are highly dedicated, risk averse and committed to teamwork and collaboration.2 They want satisfying work opportunities that are stable, and they appreciate the personal touch such as handwritten notes.1

PRECEPTORS

Preceptors from the traditional generation should try to understand that the formality and stoicism of their generation seem old-fashioned to younger generations, and it means less to them than meaningful or genuine interactions. Also, while paying your dues is important to traditionals, younger generations believe if you are talented and work hard, then you should be given a chance to prove yourself. However, traditionals, Millennials, and generation Z do have a trait in common: their sense of duty. While traditionals’ sense of duty is more targeted to their country or employer, generation Z’s sense of duty is more targeted at a cause. Younger generations and older generations are both proud of their work, but older generations are proud of the work product, and younger generations are prouder of the experience. All generations mention wanting to contribute to the greater good as well.

STUDENTS

When communicating with the traditional generation, students should understand that a few well-chosen words of appreciation mean more to this generation. Showing respect is important to them. They expect students to work hard, to not complain and to not look for a lot of recognition. However, when traditionals do give someone praise, it is short but genuine and meaningful.

When communicating with preceptors, students should be relatively formal and direct but respectful. Do not expect a lot of positive feedback but when you get a few words of it, know it is meaningful. Appeal to their sense of duty. Be direct but polite. As they appreciate actions more than words, consider making a small card with a thank you. You may also consider doing something that saves them time, like gathering a patient’s history or test results before they get in or while they are doing something else.

Baby boomers

The baby boomer generation consists of those born between 1945 and 1965, although the exact years vary slightly depending on the source. This generation witnessed and partook in the political and social turmoil of their time: the Vietnam War, the Civil Rights Movement, the John F. Kennedy and Dr. Martin Luther King, Jr. assassinations, as well as Woodstock and the freewheeling 1960s.2 Baby boomers grew up in an era of prosperity and optimism, bolstered by a sense that they are a special generation capable of changing the world. They respect authority but do not always trust it. Many are accepting of diversity, more politically liberal, conflict avoidant, and relationship oriented. They have a fierce sense of right and wrong and love a noble cause. Baby boomers have been described as the “Show Me Generation,” which translates to words meaning little to them and actions meaning more.2

PRECEPTORS

The baby boomer generation will tend to look on the bright side and hold back criticism due to their optimism and conflict avoidance. However, because actions mean more to baby boomers than words, their verbal or written communication can come across as being insensitive and harsh to younger generations as the younger generation value words more. Being mindful of their words and avoiding “you” terms that can be interpreted as a personal attack is helpful. If they must give negative feedback, addressing the action and not the person is interpreted less harshly.

STUDENTS

When communicating with baby boomer generation, one should be diplomatic as to not come off confrontational. Confrontation can be interpreted as disrespect, which is something this generation will not tolerate well. Since they value actions, students should work hard and point out what their actions mean. Speak up if you have ideas, as boomers enjoy innovation. Keep a higher ground stance and appeal to their sense of right and wrong.

Generation X

Generation X (also known as Gen Xers) are those born between approximately 1965 and 1980. In a manuscript from the University of Minnesota, A. Tolbize (2008) noted that Gen Xers grew up in a period of financial, familial and societal insecurity associated with an immense recession. They witnessed their parents being laid off along with the decline of the American global power. Additionally, Gen Xers grew up with a stagnant job market and corporate downsizing with limited wage mobility, making them the first individuals predicted to earn less than their parents did.2 They grew up in homes where both parents worked, which created a latch-key kid generation where they were obligated to fend for themselves. They were influenced by music television, the HIV/ AIDS epidemic, the fall of the Berlin Wall and their mantra in high school was question authority, because they felt authority had let them down.3

Due to their economic hardships, Gen Xers started to walk away from the workaholic lifestyle of the previous generation.2 They value a balance between work and life, are fiercely independent, entrepreneurial, pragmatic and creative. They value actions more than words, and accomplishment more than money.

PRECEPTORS

Much like the boomers, a Gen Xer’s words may come out harsh to younger generations at times. They tend to be straight to the point and less formal. They will notice when a student is trying their best or putting in more hours and be more likely to acknowledge hard work over intelligence. Being mindful of these personal tendencies will hopefully help mitigate them. Learning to give impersonal, balanced feedback with positive reinforcement and not only what the student does wrong can make interactions more meaningful.

STUDENTS

When communicating with the Gen X generation, be direct and practical. Do not be afraid to share ideas. As mentioned previously, Xers appreciate innovation. Students should show some independence and initiative, like looking things up before they are told or finding a patient’s test results that they know the preceptor is awaiting. Asking thoughtful questions also shows that students are listening and trying to learn and not just going through the motions or biding time until they can leave. Preceptors can tell who is really trying and who is not.

Generation Y aka Millennials

Millennials are those born 1980–2000, depending on the source. They are predicted to make up 75% of the workforce by 2025.1 This generation has been shaped by parental excesses, computers with dramatic technological advances and relative peace. As a result, Millennials are optimistic idealists. They value respect, being heard, dedication and they want leaders who display these qualities. Millennials hold steadfast to ideas or causes but not as much to people or employers.2 They value meaning and validation, and they want to contribute positively to the world.

Due to having increased interaction with technology, words mean more to this group, and they are more idealistic than their predecessors.2 Millennials desire a more balanced life that the Xers and have been characterized as “demanding” because they have a high expectation of those in authority.2

PRECEPTORS

Millennials have grown up in an increasingly multicultural society and appreciate diversity. They grew up with technology, change and political turmoil, so they are adept at going with the flow. Millennials are now the largest generation, because the baby boomer population is shrinking.1 They are much more politically and socially liberal, as well as connected digitally. Because of the significant digital communication that they have grown up with, they are used to things being clear and categorized, and they prefer it that way. For example, an educator may be teaching a millennial something all day, but if the educator does not say “I am going to teach you now,” it could be possible that the point is missed completely by the Millennial because they may not realize what is happening. The intention of using specific words to relay what is happening or what needs to be observed by the student allows for better understanding because it is made clear to the learner at the beginning.

Millennials tend to expect a quick return of information. For example, if a millennial sends a presentation to an educator via email, they will expect an acknowledgement of receipt. They much prefer digital communication rather than phone calls, which can cause anxiety as they interrupt their day. Communication via phone may be more reactive and does not allow for well-thought-out ideas. They are likely to return emails on the weekend or at night because they view emails as less urgent than text.4 Millennials also tend to be less formal in their communication and seek connectivity with their coworkers and boss, even outside of work. This may be more difficult for older physicians because they were trained to view this as taboo and keep professional boundaries. It is acceptable to continue to lay firm boundaries but be sure to clearly articulate the reason with positive communication. As mentioned previously, they appreciate validation and knowing they are contributing to the betterment of the world as well. Therefore, their contributions should be acknowledged or pointed out to them if they cannot see it for themselves. Feedback, especially if negative, should be framed as helping to make them better for their future patients and the greater good.

STUDENTS

As students in this generation, it is important to “know thyself,” as well as understand where your preceptors are coming from. While you are likely to be more technologically advanced than many of your preceptors due to your exposure, keep in mind that the generations before you did a lot more with a lot less of the technological advances that you have had the opportunity to know. Respect their contribution, just like you want them to respect yours. If your preceptor does not email or text you back right away or accept an invitation, it does not mean that they are ignoring you or do not like you. They just are more comfortable with a more distinct set of boundaries. However, if they do reach out to you by email or text or phone, they must think it is important, so respond as soon as reasonable.

Generation Z

Generation Z or Gen Z are people born around 1995–2010. They are just now entering the job market, so their characteristics are not yet fully known. They are called “digital natives” because they have known technology since they were born. They are deeply attached to technology and expect employers and schools to embrace it. Due to witnessing turbulent times and political turmoil, Gen Z has less trust for authority and believes respect is earned—much like traditionals. They value meaning and are motivated to contribute positively to the world. Members of Gen Z are technological idealists and social justice warriors.5

Generation Z is the most racially and ethnically diverse in history.6,7 While they embrace diversity and expect their leaders to do the same, their perception of the world is smaller because of technology, using technology for communication more than any other generation. However, 72% of Gen Z workers prefer face-to- face communication at work, 11% prefer texts and 9% percent prefer email.8 Another study found that Gen Z respondents were more likely than technology-obsessed Millennials to value face- to-face communication, with an emphasis on effectiveness over convenience.9

PRECEPTORS

A study by The Center for Generational Kinetics found that 60% of Gen Z members prefer multiple check-ins with the boss during the week, and 40% of those workers would prefer that those check-ins to happen at least daily.8 If these check-ins and interactions do not happen regularly, a Gen Z worker is likely to think that they have done something wrong.10 Therefore, professors and preceptors should understand that this generation will request frequent and instant feedback, although it does not have to be lengthy. A few words of affirmation or correction will suffice, and it may be beneficial to carve out a set time at the beginning or end of the day to give more formal feedback. Appeal to their beneficence and point out how they are contributing to the good of their patient or the community.

STUDENTS

Try not to stereotype your preceptors as “less connected” or in tune with technology, even though they may be. Gen Z’s characteristics are a lot more like those of Gen X than one may think in that both like direct face-to-face communication and value innovative ideas. Preceptors tend to be busy, and they want to teach, or they would not have signed up. If they cannot give you the feedback or attention you feel you need exactly when you feel you need it, be patient. Perhaps ask for a few minutes to discuss something at the end of the day or after you have had a chance to find it yourself. Offer to research new findings or guidelines and share them. Ask well thought out questions and try to look things up while you are waiting, ensuring you avoid doing so while with a patient or while someone is talking to you as that can come off as disrespectful, if they are unsure what you are doing.

CONCLUSION

While this report focused on the differences between the generations, it is notable that several generations have similar descriptors, although the magnitude of how much that descriptor applies is what changes over time. For example, traditionals, boomers and Gen Xers, all value action more than words, but that characteristic became less prominent over time. While Millennials and Gen Z both value words more than actions, it seems more prominent in Gen Z so far. It is also notable that beneficence is a common thread throughout the generations. It seems wanting to know that we are contributing to the greater good is a universal attribute.

Because empathy comes from being able to put oneself into another person’s shoes, understanding each other’s backgrounds that contribute to our personality traits will contribute to our empathy as well. This will hopefully improve our communication and, therefore, our teaching results. Knowledge of generational differences can also be used by students and preceptors in their communication with patients, ultimately improving patient care as well.

These are broad generalizations, and other factors—such as personality type, cultural background and personal history— may keep some people from being stereotypically like the rest of their generation, which is why getting to know learners by asking them about themselves and their goals is important for both the teacher and the learner. Keeping these typical characteristics in mind when interacting with members of these generations, however, can improve communication all around. In medical education, improved communication can facilitate better learning and more productive and pleasant experiences for the teacher and the learner.

REFERENCES:

1. Purdue University Global. Generational differences in the workplace. 2021. Accessed June 7, 2021. https://www.purdueglobal.edu/education- partnerships/generational-workforce-differences-infographic/

2. Tolbize A. Generational differences in the workplace. University of Minnewota Research and Training Center on Community Living. August 16, 2008. Accessed June 7, 2021. https://rtc.umn.edu/docs/2_18_Gen_ diff_workplace.pdf

3. Phillips-Fein K. What’s left of generation X. Dissent Magazine. 2019. Accessed June 7, 2021. https://www.dissentmagazine.org/article/ whats-left-of-generation-x

4. Alton L. Phone Calls, texts or email? Here’s how Millennials prefer to communicate. Forbes. May 11, 2017. Accessed June 7, 2021. https://www.forbes.com/sites/larryalton/2017/05/11/how-do- millennials-prefer-to-communicate/

5. Frances T, Hoefel F. ‘True gen’: Generation Z and its implications for companies. McKinsey & Company. November 12, 2018. Accessed June 7, 2021. https://www.mckinsey.com/industries/consumer-packaged- goods/our-insights/true-gen-generation-z-and-its-implications-for- companies?cid=eml-web

6. Western Governors University. Who is gen Z and how will they impact the workplace? February 17, 2021. Accessed June 7, 2021. https://www.wgu.edu/blog/who-is-gen-z-how-they-impact- workplace1906.html

7. Parker K, Graf N, Igielnik R. Generation Z looks a lot like Millennials on key social and political issues. Pew Research Center. January 17, 2019. Accessed June 7, 2021. https://www.pewsocialtrends.org/2019/01/17/ generation-z-looks-a-lot-like-millennials-on-key-social-and-political- issues

8. Campiere A. How generation Z communicates at work. PCMA. February 14, 2019. Accessed June 7, 2021. https://www.pcma.org/how-generation- z-communicates-work/

9. Yozell Associates. Generation Z values face-to-face business communication. Employee Benefits Newsletter, 60(2). February 28, 2017. Accessed June 7, 2021. http://yozell.com/blog/generation-z-values-face- face-business-communication

10. The Center for Generational Kinetics. The state of Gen Z™ 2018: Annual study and key discoveries. 2018. Accessed June 7, 2021. https://genhq.com/generation-z-research-2018