Teaching Across the Generation Gap: Consensus from the CORD Generational Learning BreakOut

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Teaching Across the Generation GapConsensus
from the CORD Generational Learning Break-Out

• Lisa Moreno-Walton, MD, Moderator
• Associate Program Director, Assistant Professor
• Louisiana State University Health Sciences
  Center,
• New Orleans

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Definition of Generation

• Span of 15-20 years
• Shaped by same political and social events in
  history
• Shaped by the parenting styles of the time
• Share common beliefs and expectations
• Share common behaviors

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Characteristics of Gen Ys and Late Gen
XersandHow that Effects Being a Resident
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• Come from child centered families
• Just being there is enough
• Entitlement
• High maintenance
• Whats in it for me i.e. loyalty issues
• Idealists i.e. things should be good
• Discipline v. correction
• Lots of feedback (esp. positive feedback)
• No need to adapt to styles of other
• generations

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• 2. The Techno Generation
• ADHD good multi-taskers
• Distractible
• In need of constant stimulation
• Must learn something every minute
• Why learn? and Why read?
• Knowledge can be acquired instantly
• with technology
• Want to learn just in time, not just
  in
• case

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• Grew up in the age of scientific advancement
• Analytical learners
• Want to know why things are as they
• are
• Why do I need to know that?
• Why do I need to do it that way?
• Need clear cause-effect relationships
• Believe in consequences only if they
• are consistent

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• Wellness has been a goal for residency during
  their entire exposure to medicine
• The work-life balance
• Real life is not work
• Life is better than work
• Life activities Wellness therefore
• work activities must illness

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• 5. Parenting and schooling taught them that there
  are no consequences
• Only peer pressure matters
• A good excuse is I never got the e-mail
• Lack of personal responsibility
• Lack of professionalism

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Societys Image of the Doctor

• Loss of secondary gains in view of their sense of
  entitlement
• Service providers (like your plumber)
• The concept of sacrifice (they are entitled)
• The concept of patient centered care (Its all
  about me.)
• The concept of loyalty to medicine that we have
  known since Hippocrates (they are from child
  centered families loyal to self)
• Use of first names
• Coolness as an image (TV influence of Scrubs
  and Greys Anatomy)

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Well never be able to change it, so what can we,
as Program Directors, do to resolve these issues
and make our residents better doctors?
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Two themes

• If we, as parents, educators, members of society
  made them who they are, we can intervene to make
  they who they can be.
• We need to find out why they became doctors and
  where they are hoping to get as doctors, and play
  to it.

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Establish the Rules

• Establish expectations early.
• During the interview, let them know who we are
  and what we expect. Do they want to become a
  part of our mission?
• We expect our residents to take ownership of
  their residency and their learning.
• Find out why they chose medical school.

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Establish Rules and Consequences During
Orientation

• Orientation Booklet Write it down!
• Consider adding items related to modern
  technology (blogging, Face Book, reading hospital
  e-mails Q 24 becomes part of the contract?)
• It should clearly state consequences.
• Review it with them.
• Have them sign a statement of understanding and
  compliance.
• Let them be part of the annual review and update
  of the manual.

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Increase the Use of Feedback

• Constructive separate personality from action
• Give them the because
• The open faced sandwich This is the task you
  need to master, this is how you will do it, now
  for closure, you will give me feedback on how
  that works out.
• The Shock Value Exit Letter If you graduated
  today, this is how your letter of recommendation
  would look.

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Tell them why they need to learn it!

• If you dont know the anatomy of the neck, you
  cant put in a central line safely.
• You cant pass the Boards without this knowledge.
• You will never be able to hold a job if you cant
  learn to come to work on time.

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Establish personal responsibility

• Spell out the task specifically for learning
  goals, clinical goals, and non-clinical
  behaviors.
• Involve them in setting these goals.
• Let them know your expectations.
• Let them know the consequences of failure to meet
  goals and expectations.
• Be obnoxiously and rigidly consistent.

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Time to return to the basic values

• Loyalty to the patient is our first
  responsibility and is expected.
• Staying late to finish an LP-pelvic-rectal
  doesnt mean not having a life, it means patient
  loyalty.
• Set clear cut rules about appearance, behavior
  and demeanor.
• Loyalty to the department We are proud of our
  residency and work hard to make it what it is.
• Loyalty to Emergency Medicine You are EM to the
  patients and consultants you encounter. Be
  worthy of that.

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Faculty Buy-In to Good Parenting

• Faculty must all model good professional
  behavior.
• Faculty must all enforce the rules.
• Consequences for not following the rules must be
  consistent.
• All faculty must jointly and consistently enforce
  these consequences.
• PD must help faculty who set their priorities
  based on popularity and being the residents
  friend.
• Faculty must set clear goals for each patient
  encounter and each shift, as well as for resident
  education and professionalism in general.

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Use Peer Pressure

• If residents suffer because of another residents
  irresponsibility, they need to know this. (Ex
  resident does not recert for ACLS and cannot work
  his shifts until he does.)
• How many pelvics and guiacs does a resident have
  to sign out before his peers say no more?
• Have them prepare lectures for students and get
  evaluated by the students.
• Make use of 360 evaluations

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Increase the use of mentoring

• They like high quality feedback.
• They like prompt feedback.
• They like personal contact with their
  instructors.
• We need to model good doctor behaviors.
• We need to improve their level of personal
  accountability and responsibility.

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Conference Learning

• Plain old power point is dead.
• If it must be power point, it must be interactive
  and jazzy. Create visual metaphors for concepts.
• Base conference on cases they see and things they
  need for the Boards, and tell them this.
• Establish the learning goals and objectives
  clearly.
• Use multi-modal techniques to combat
  distractibility and tendency to text or answer
  e-mail.

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Conference Learning

• Use of audience clickers with immediate
  feedback.
• Give high quality feedback.
• Use small groups often. They excel at team work.
• Small groups need a defined, realistic task.
• Give answers right away.

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Thoughts on Didactic Learning

• Can we use instant messaging or live chat
  discussion?
• Is more asynchronous learning what we really need
  ?
• Increase the use of simulation.
• Consider the use of pod casts.
• They love to trade DVDs.
• Developing small group and asynchronous learning
  modules is very time consuming.
• Should we have a task force to develop small
  group modules and then share all of them among
  the membership?

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Suggestions for Generational Learning, questions,
interest in a task force?

• Please contact me
• DoctorMoreno_at_gmail.com
• Louisiana State University Health Sciences
  Center, New Orleans