Bryan Pardo, MD, Heidi Allespach, PhD, Joan E. St Onge, MD, Yvonne Diaz, MD
University of Miami Miller School of Medicine/Jackson Memorial Hospital

Millennials (born between 1984-2004) view the world in a radically different manner than do their Baby Boomer and Gen X faculty. It can be argued that a leading contributor to burnout is the exquisite tension and profound discrepancy between the world views of older teachers and their younger learners. It seems that never before in the history of medical education has the world been so technologically and socio-culturally complex, and the chasm between generations so wide. Much has been written about the topic of physician burnout in recent years.[1-3] Recently, the Accreditation Council of Graduate Medical Education identified goals to broaden efforts to promote resident wellness[4]. However, whilst wellness strategies have been implemented by numerous organisations to combat burnout, the numbers of physicians who are depressed and stressed-out still continues to rise. Collective efforts to date to help these struggling learners, whilst well-intentioned, have been unsuccessful. It is critical that we now examine this phenomenon from a different perspective.

This cohort has grown up saturated by rapidly evolving technology and constant stimulation at their (literal) fingertips. Hence, it should come as no surprise they also expect convenience, easy access, and instant control of their health and wellness. This expectation is often smashed by the rigors of traditional medical training, causing the learners of this generation to succumb to a sort of “reality vertigo”[5] wherein they question all that they had known and valued prior to entering into the swift, unpredictable stream of medical education. Millennials have been described as having qualities of confidence and tolerance, but also entitlement and narcissism[6]. Stress management strategies which may have worked well for previous generations may be perceived by Millennials as not having the instant “pay-off” they seek. Rather than completely disposing of effective interventions, such as relaxation exercises and guided imagery, we need to learn to listen to this unique group of learners and teach techniques in smaller “chunks” which can be tailored to the specific individual and available “on-demand,” such as short relaxation exercises, or even a condensed delivery of cognitive behavioral principles.[7]

Encouraging Millennial learners to identify a wellness activity of their own choosing, and to participate in this activity at least 15 minutes daily[7], will likely further the Millennial learners’ sense of control. It is important to note that wellness activities should be afforded protected time; for example, embedding a brief 10- minute block dedicated to wellness activities within ongoing curricula. Traditional means of teaching can be given new meaning, and time spent in conference can be repurposed to meet dual needs, as in the concept of “Vitality Rounds,” an inversion to the morbidity and mortality conference in which residents present encounters where good practice achieved good outcomes: a chance to both learn and appreciate the hard work residents do.

Older educators should listen, and then adapt their perspectives, to what this cohort of learners wants and needs and consider the idea that former teaching models may not be as effective with this generation. The need for immediate and accurate recall of medical knowledge reinforced by traditional clinical teaching is beginning to give way to a need for point-of-care access to current expert consensus and a facility with research; perhaps we should reward resident learners who make the effort to go beyond rote memorisation to understand the concepts therein. Advanced mobile technology, such as smartphones and tablets, as vehicles for easy accessibility to wellness strategies, seem to be especially valued by this generation of learners. Well-made mobile apps such as meditation guides are a way of teaching wellness strategies in a piecemeal fashion which appear to be particularly beneficial for this cohort.

If it is true that “insanity is doing the same thing over and over, each time expecting different results,” then we, as postgraduate medical educators, should consider revisiting the manner in which we teach this generation of unique learners. We should challenge ourselves to perceive the world through their eyes in order to become more compassionate and empathic, whilst still setting standards of excellence and accountability. Only then can we intervene by developing meaningful and valued wellness strategies which help to increase the resilience and control needed to prevent burnout among our graduate medical learners.

References
1. Tawik DS, Profit J, Morgenthaler TI et al. Physician burnout, well-being, and work-unit safety grades in relationship to reported medical errors. Mayo Clin Proc. 2018 Jul 4. [Epub ahead of print]
2. West CP, Dyrbe LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018; 283(6):516-529.
3. Shanafelt TD, Dyrbye LN, West CP. Addressing physician burnout: The way forward. JAMA. 2017 Mar 7;317(9):901-902.
4. Daskivich TJ, Jardine DA, Tseng J et al. Promotion of wellness and mental health awareness among physicians in training: perspective of a national, multispecialty panel of residents and fellows. J Grad Med Educ. 2015; 7(1):143-147.
5. Pomm HA. Regaining balance after “Reality Vertigo:” Teaching learners to attend to the psychological aspects of patients with chronic, nonmalignant pain. Family Medicine. 2006;38(2):86-89.
6. Twenge, J. M. Generation Me: Why today’s young Americans are more confident, assertive, entitled—and more miserable than ever before. 2006; New York: Free Press.
7. St. Onge JE, Allespach H, Diaz Y, Burg MA. “Promoting Wellness: Multispecialty Learning Communities for Interns.” Presented at the Learning Communities Institute Annual Meeting at the University of Washington, November 2016