The Dynamics of Millennials in Medical School

Generational Differences among Learners:
Theory, Research, and Educational
Implications
Nicole J. Borges, PhD
Assistant Dean, Medical Education Research
and Evaluation
Professor, Department of Community Health
Outline


How Millennial are you?
Characteristics of Millennials
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Research
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
Neil Howe & William Strauss, Millennials Rising: The Next
Great Generation. Vintage Books: New York, 2000.
Lynne Lancaster & David Stillman, When Generations Collide:
Who They Are. Why They Clash. How to Solve the
Generational Puzzle at Work. Harper Business: New York,
2002.
Personality, Motives, Meta Analytic Studies
Learning Environment
Acknowledgments

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Carol Elam, EdD, University of
Kentucky College of Medicine
Jennifer Brueckner, PhD, University of
Louisville School of Medicine
No conflicts of interest or disclosures
Which was your first phone?
Dollinger & Von Harscher, 2011
FWIW IMHO NE1 cn LRN 2 TXT
FWIW IMHO NE1 cn LRN 2 TXT
for what its worth in my humble
opinion anyone can learn to text
S2S I?4U IT2M2H & LNT
S2S I?4U IT2M2H & LNT
Sorry to say I have a question for
you, is this too much to handle and
lost in translation
Case 1
A faculty member posts her PowerPoint™ presentations
online in the school’s course management system prior
to each lecture. In class, however, this faculty member
presents a slightly different version of the lecture than
what was posted online. She incorporates additional
details, images and examples during her presentations,
configuring her lectures so as to encourage class
attendance and active learning in the classroom.
Several students file formal complaints with the course
director, stating that the professor should post the same
version of her lecture online as she presents in class.
The students state that they learn more effectively and
efficiently through independent study of the
PowerPoint™ files, as compared to attending the live
lectures, and they are put at an academic disadvantage
on exams as a result of this professor’s practices.
Generational Cohorts
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G.I. Generation (1901-1924)

Loyal and Patriotic
Silent Generation (1925-1942)

Conforming
Boom Generation (1943-1960)

Idealistic and Competitive
Generation X (1961-1981)

Skeptical and independent
The Millennials (1982-2002)
 Optimistic, achieving, and collaborative
Summary of Millennial
Characteristics from Population
Theorists
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Hard Working, Pressured
to Excel
Raised by supportive
parents, trust their
parents, sheltered
Accustomed to having
their time structured,
working from schedules,
following rules
Confident and optimistic
about their talents,
“special”
Appreciation for diversity
Needs for safety
Respectful
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Used to achieving set
goals
Collaborative and team
oriented
Want to know “rules of
the game” and expect
rules to be adhered to
Technologically savvy
Multi-taskers
Oriented toward
community service and
improving their
communities
Lack of
introspection/self
reflection
Challenges with Millennial
Generation

Sense of entitlement

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Complaining to the top, not going through
proper channels

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want suggestions/concerns to be heard
Unrealistic expectations about how to achieve
goals

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want value, accountability, consumerist attitudes
may need guidance from mentors/senior students; may not
seek help
Pressured overachievers…

want balance in life yet are overextended and overwhelmed

What data are available to document the
differences between generations?
Medical School Millennial Students:
A Comparison with Generation Xers
(Borges, Manuel, Jones & Elam, Academic Medicine, 2006)
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Using the 16PF questionnaire
N= 809 (90% response rate)
Compared responses of medical
students enrolled between 1989 and
2004
555 (68%) were Generation X students
254 (32%) were Millennial students
399 females and 410 males
Sixteen Personality Factors
Warmth
Liveliness
Vigilance
Openness to
Change
Reasoning
Rule
Consciousness
Abstractedness
Self-Reliance
Emotional
Stability
Social
Boldness
Privateness
Perfectionism
Dominance
Sensitivity
Apprehension
Tension
Red = Millennials Higher
Blue = Generation Xers higher
Black = No difference
Differences in Achievement Motivation
between Millennials and Generation Xers
(Borges, Manuel, Elam & Jones, Medical Education, 2010)
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Achievement Motivation (Thematic Apperception Test; TAT)
 Need for Achievement
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Need for Affiliation
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The motive to share defined by a need to interact with,
share with and be liked by others, feel a sense of
involvement and “belonging” with a social group
Need for Power
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The motive to succeed with a strong need for feedback and
progress, and a need for a sense of accomplishment.
The motive to succeed while influencing others, having ideas
prevail, and making an impact with a strong need to lead.
426 medical students (229 = Gen X, 197 = Millennials)
Millennials scored higher on Affiliation and Achievement
Generation Xers scored higher on the motive of Power
Generation Me:
Meta Analytic Studies and Findings
Today’s students score
higher on
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Assertiveness
Self-liking
Narcissistic traits
High expectations
Stress, anxiety
and poor mental
health
Today’s students score
lower on


Self Reliance
J. M. Twenge, Generational changes
and their impact in the classroom:
teaching Generation Me. Medical
Education 2009;43: 398-405
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Intellectual skills
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Higher Expectations
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Scoring more highly on intelligence tests,
particularly reasoning ability and math
Fewer students read books
Students have made excellent grades
previously
High Self-Esteem, Perfectionism,
Overconfidence
Mental Health Problems
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Anxiety and depression are higher in this
generation
Stress is inherent in medical education
process….
Narcissism and Entitlement
Narcissism
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Overconfident,
self-centered,
lack empathy for
others
Entitlement

The world owes
you something…I
deserve the best
Twenge’s Recommendations
learning environments
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Recognize that students need to understand
the purpose and meaning of activities
Emphasize learning by doing
Break up lectures with pictures, graphics and
short video segments
Use audience response system, team learning
For students requesting special treatment:
all students should have same advantages
Do not compromise on content that must be
learned
Millennial Students’ Perspectives on
the Medical School Learning
Environment (Elam, Borges, & Manuel, 2011)
Explore medical students’
perceptions of characteristic
Millennial attitudes and
behaviors.
 Focus groups: First-year (n = 14)
and third-year students (n = 9)
from two medical schools
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attitudes toward various learning
approaches;
uses of technology to manage information;
examples of helpful feedback;
necessary knowledge and skills for
culturally sensitive care;
strategies to maintain balance as a student
and physician;
attitudes towards service and civic
responsibility;
institutional accountability and necessary
support services
Results
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Millennial medical students prefer hands-on
learning experiences in a non-competitive
environment, behaviorally-based & individualized
feedback, and use of technology to manage
information.
Students want exposure to different cultures in the
clinical setting.
Students value community service experience and
exposure.
They recognize difficulties in maintaining a healthy
balance in their lives.
Students desire help with transitions to medical
school, improved advising and mentoring, and
assurance of education on the cutting edge.
Live Lectures vs. Video-Recorded
Lecture (Cardall et al., 2008)
Most important reason
for attending live
lecture.

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Not motivated to watch the
recorded lectures on my own
To show professionalism and
respect for the instructor
To talk with classmates
So I feel like I am getting more
out of my tuition
I learn better live
Most important reason
for replacing class
time with personal
learning time
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So I can use learning methods
that work better for me
Because it allows me to watch
the lectures at any time of
day/structure my day to
improve my productivity/sleep
To watch lectures at my own
pace
So I can set my own learning
priorities
How Should We as Educators
Prepare and Respond?
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What are the implications for changing the
teaching-learning relationship?
What can faculty and administrators
expect from Millennial students?
How responsive should we as educators be
to the students’ characteristics,
preferences, qualities?
Case 1
A faculty member posts her PowerPoint™ presentations
online in the school’s course management system prior
to each lecture. In class, however, this faculty member
presents a slightly different version of the lecture than
what was posted online. She incorporates additional
details, images and examples during her presentations,
configuring her lectures so as to encourage class
attendance and active learning in the classroom.
Several students file formal complaints with the course
director, stating that the professor should post the same
version of her lecture online as she presents in class.
The students state that they learn more effectively and
efficiently through independent study of the
PowerPoint™ files, as compared to attending the live
lectures, and they are put at an academic disadvantage
on exams as a result of this professor’s practices.
Discussion Questions
Do the students have a valid complaint to the
course director? Why or why not?



Would your answer differ if the students were regular
attendees at each lecture, versus students who only
accessed lecture recordings online? Why or why
not?
How should the course director respond to the
students’ request? How should the course
director broach this issue with the faculty
member in question?
Thank you !
“A
challenge remains for
educators to incorporate
technologies students find
useful while creating an
interactive learning
environment”
Cardall et al., 2008
References







Neil Howe & William Strauss, Millennials Rising: The Next Great
Generation. Vintage Books: New York, 2000.
Lynne Lancaster & David Stillman, When Generations Collide: Who They
Are. Why They Clash. How to Solve the Generational Puzzle at Work.
Harper Business: New York, 2002.
Borges, N.J., Manuel, R.S., Elam, C., & Jones, B.J. (2010). Differences in
Motives between Medical School Millennials and Generation Xers. Medical
Education, 44, 579-576.
Borges, N.J., Manuel, R.S., Jones, B.J., & Elam, C. (2006). Comparing
Millennial and Generation X medical students at one medical school.
Academic Medicine, 81(6), 571-576.
Cardall, S., Krupat, E., & Ulrich, M. (2008). Live Lecture Versus VideoRecorded Lecture: Are Students Voting with Their Feet? Academic
Medicine, 83, 1174-1178.
Elam, C.L., Borges, N.J., & Manuel, R.S. (2011). Millennial Students’
Perspectives on the Medical School Learning Environment: A Pilot Study
from Two Institutions .Medical Science Educator, 21(2), 20-22.
Twenge, J.M. (2009). Generational changes and their impact in the
classroom: teaching Generation Me. Medical Education; 43, 398-405.

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