How to train the next generation of orthopaedic surgeons ...

“Every generation thinks it has the answers, and every generation is humbled by nature” ~Phillip Lubin

"I hate Generation X," one of my mentors used to say. Generation X was a term given to my generation and most of those who are in residency now. This term was given to us based on a book by Douglas Coupland titled Generation X. In this pivotal book that defined my generation, there are three strangers who decide to distance themselves from society to get a better sense of who they are. He describes the characters as "underemployed, overeducated, intensely private and unpredictable." I don't know if that defines me, but it does point out some important characteristics of my generation (born between ~1965-1980). Why did my mentor have a distaste for us? We never wronged him in anyway. But, what we did is challenge him to teach in a different way. We did not respond to some of the teaching styles of the past. We required him to change, and who likes to change?

Looking at training today, many of those so hated Gen Xers are now in the positions of educators. Many of those from the Silent Generation are gone or are Emeritus Professors; and those of the Baby Boom generation are making their way up the ladder of academia and in their business and practice. The next generation, my generation, is being groomed to fill in for those from the previous generations. Now, what are we going to do with the next generation that will be making it's way into residency and eventually into practice? This is the generation known as Mellenials, Echo Boomers, or Generation Y. I have a feeling I am going to hate this generation. (grin and wink)

How do we train the next generation of orthopaedic surgeons? As I was taught in public speaking, one of the most important things in preparing a lecture/talk is to know your audience. Even though my mentor made the statement of distaste for my generation, I know for a fact that he did take the time to understand us. So, who is this coming generation? Well first lets us travel back in time to understand some of the previous generations and the basic characteristics (generalizations) that are common to those generations.

First, let's discuss the Silent Generation. This was the name given to the generation that came of age in ~1925-45 this generation in a Time cover story of Time referring to a generation described as "withdrawn, cautious, unimaginative, indifferent, unadventurous and silent." They looked for job security offered by big corporations (2% where self employed). Because they were born around the time of the great depression and WWII, many of this generation felt they were a generation without a cause. Silent Generation knew hardship and knew how to struggle through tough times. This was the earliest marrying group in American history with Men marring at an average age of 23 and women at 20. Ninety four percent of women became mothers and stayed at home raising an average of 3.3 children. This generation started the "divorce epidemic" as men and women born between 1930s and 1940s showed the biggest age bracket jump in divorce rate (No fault divorce laws jumped from zero to forty-five). Training the silents was like being in boot camp. Residencies were true residencies and the match was just coming into effect in the 1950's, so many went through the period of being coerced into a residency. This was the generation that worked hard and complained little.

The next generation is the Baby Boom Generation. The Baby Boomers, of course, are the product of post-war enthusiasm by returning GI's. This generation, from its infancy, was granted opportunities which were absolutely unprecedented in the history of the nation. New schools were built all over the land, suburbs allowed for a non-urban development of children, new technology paved the way for much higher standards of living (domestically, industrially, and medically), and overall economic windfalls from the war effort gave this generation a starting platform which all but ensured success and equality for all future generations of Americans. A great many of this generation, particularly those raised near large or major cities, not only went to college but began to see where the basic faults of the social contract became glaring problems. There should be no poverty in a nation which possesses such a strong economy and thriving industry. There should be no hunger for anyone when there is more than enough food to feed everyone. The government, in essence, was seen by these young adults as a vehicle by which every member of society could turn to for assistance when needed. The big problem for this generation was, of course, the war in Vietnam. Without delving into the military reasons for the war's failure, or even the government's justification for going to war, it is essential to focus on the social impact that it had on this generation. This was without a doubt the first social hiccup that the Baby Boomer's had ever faced. The Utopian ideal, which had so carefully been planned and administered by their parents (through education, modest upbringing, and technological advancements), was finally coming unraveled. The greatest impact the war had was that it shattered the illusion that had so carefully been designed for them by their parents. Crime did exist, racism is all too real, and corruption and greed are powerful forms of coercion which exist even in the sacred halls of Congress and the White House. The protest movements of the 1960's and early 1970's were an acknowledgment by this generation that the cat was out of the bag; Santa Clause, the Tooth Fairy, and the Easter Bunny do not actually exist. Most of the physician Boomers were sent to Vietnam, if they were of age, and where trained in the days of the screamers and throwers. Some of them have that more aggressive type of teaching. By many in my generation, it was termed malignant.

Now let's talk about the best generation, Generation X. We were brought up on television, Atari 2600s and the first personal computers. Our generation was raised in the 1970s and 1980s, and saw this country undergo a selfish phase that we do not want to repeat, so well depicted in the novel by Bret Easton Ellis, American Psycho. Born between~ 1965 and 1980, we grew up in a very different world than previous generations. Divorce and working moms created "latchkey" kids out of many in this generation. This independence led to traits of independence, resilience and adaptability. Because we were never accustom to it, the was a general sense that "I don't need someone looking over my shoulder." At the same time, we expect immediate and ongoing feedback, and are equally comfortable giving feedback to others, something that frustrated my mentor. Many saw their parents get laid off or face job insecurity, and at the same time many entered into the workforce in the 80's when the economy was in a downturn, causing them to redefined their loyalty. That being said, many of us do take our employability seriously; looking at our career as more of a lattice than a ladder. We move laterally, stop and start, their career is more fluid. Even more so than Baby Boomers, Gen xers dislike authority and rigid work requirements. They preferred a mentorship that was more hands-off, but at the same time wanted their mentors to provide feedback on their performance. They also desired that feedback to be encouraging of their creativity and initiative. There was a desire to work with the mentor and not for the mentor. Gen Xers work best when they're given the desired outcome and then turned loose to figure out how to achieve it.

Now we have arrived at today's generation. Some have referred to them as Generation X on steroids. They are known as the Millennial Generation, these are those born ~1980 and 1998. This generation has been raised at the most child-centric time in our history. I personally refer to them as the BABY ON BOARD or soccer mom generation. Perhaps it's because of the showers of attention and high expectations from parents that they display a great deal of self-confidence to the point of appearing cocky. Technology has always been part of their lives, whether it's computers and the Internet or cell phones and text pagers. Because of their upbringing they are typically team-oriented, banding together to date and socialize rather than pairing off. They work well in groups, preferring this to individual endeavors. Multitasking is almost an inborn trait, having juggled sports, school, and social interests as children. Because of this experience, they seem to expect structure in the workplace. They acknowledge and respect positions and titles, and want a relationship with their boss. This is actually at odds with Generation X's love of independence and hands-off style. They tend to respond well to the personal attention. Because they appreciate structure and stability, educating and mentoring them needs to be more formal. There needs to be a set structure and a more authoritative attitude on the educator 's/mentor's part. A mentor must provide lots of challenges as well as provide a structure to back it up. Millenials have been asked their opinions their whole lives; may mistake silence for disapproval.

So, now that we understand some of the differences, let's get to the point of understanding some things that will help us to get along in the work environment. Let's break it down:

What do we want?

• Silent Generation: want to be a part of the company’s future
• Baby Boomers: want to move up within the company (have huge personal and financial responsibilities)
• Generation X: want to know exactly what they’ll be doing, are they on the right career path
• Millenials: help them see the future/what role they will play

Training

• Silent Generation: “I learned it the hard way, you can, too”
• Baby Boomers: “Teach ‘em too much and they’ll leave”
• Generation X: “The more they learn the more they stay”
• Millenials: “Continuous learning is a way of life”

Feedback (Needs to travel up the ladder as well as down)

• Silent Generation: “No news is good news”
• Baby Boomers: “Feedback once a year, with lots of documentation”
• Generation X: “Sorry to interrupt, but how am I doing?” Generation Xers can be very blunt.
• Millenials: “Feedback whenever I want it at the push of a button”

Both Gen X and Millenials need training in how to give feedback that is polite, respectful, non-threatening and non-confrontational.

Rewards

• Silent Generation: satisfaction of a job well done
• Baby Boomers: money, title, recognition, the corner office
• Generation X: freedom is the ultimate reward
• Millenials: work that has meaning for me

What motivates them? What do they want?

• Silent Generation: Money, Public recognition, Desire to lead, Organizational loyalty, Responsibility, Accomplishment, and Control
• Baby Boomers: More money, Public recognition, Desire for subordinates, Loyalty to self, Promotion, Peer recognition, Control
• Generation X: Do well by doing good, Meeting organizational goals, Recognition from boss, Time off , Meeting own goals, Skills training, Mentoring

Now, having some background on my audience, I hope that I can somehow look at those medical students and residents, and figure out what teaching style will they likely respond to. At the same time, I hope that incoming medical students and residents will also look at this information and have some understanding of their educators. In the end we are in this together; we are striving for the same results. So, in the words of a great wise man named Rodney King, "can't we all get along?"

"If you want happiness for a lifetime - help the next generation.”

~a Chinese Proverb