Bridging the generation gap in the workplace: how I learned to stop worrying and love working with the millennial generation

The millennial generation (those born between 1981 and 1996) [1]—also called ‘Gen Y’ or ‘Gen Me’—has a bad rap. As new kids on the workforce block, millennials are often blamed for conflicts in the workplace. Over the past nearly 20 years of supervising successive trainees in medical education, I continue to receive an increasing number of complaints about millennial learners every year. The truth is I had not been immune to the frustrations of supervising the millennial learners myself–that is, until I have learned to stop worrying and love working with the millennial generation by reading the literature on this topic, through discussions with other colleagues, and by learning from these new kids. I hope these lessons are helpful to those from my generation (Gen X) and others, and can be applied beyond the medical education setting.

Chelsea Clinton tried to dispel misperceptions about millennials when she stated they’re ‘often portrayed as apathetic, disinterested, tuned out and selfish. None of those adjectives describe the millennials I’ve been privileged to meet and work with [2].’ Nonetheless, her statement alludes to common perceptions many others share about this group.

How generational issues create potential conflicts in the workplace has been observed in every field. This issue is particularly apparent in places where different generations share physical or employment space. Medical education is a field in which a constant wave of trainees come through and are supervised by older—self-perceived as wiser—practicing physicians and other health professionals. ‘These students/residents appear younger and younger every year,’ and ‘they are just so different from when I was trained’ are utterances I routinely hear.

Misunderstanding and conflicts arising from generational gaps occurred long before millennials arrived on the scene. Social scientists have observed that each generation is defined by distinct characteristics based on their birth years [3]. Although the line between any two generations is at times blurred, some generalizations have been helpful in understanding and integrating co-workers from different generations in the workplace. Influenced by myriad factors including world events (e.g. war and similar conflicts), financial flourishes and downturns, parenting styles, and technological advances, each generation shares unique values, goals, and attitudes toward authority and hierarchy. These, in turn, impact motivation, communication styles, personal and professional relationships, ways to handle conflicts, and the concept of work-life balance. Consequently, it is not difficult to see how a workplace where three to four generations coexist can be fraught with conflicts. Table 1 summarizes characteristics of the four generations in the current work environment [4,5].

Table 1. Characteristics of the four generations currently working together in the healthcare setting.

Generation (Birth Years)	Core Values	Goals	Strengths	Challenges
Traditionalists (1922-44)	Fiscal restraint Strong work ethic Self-sacrifice	To be respected To be valued	Service to others Loyalty Discipline	Risk averse Conformist Resistant to change
Baby Boomers (1945-64)	Ideals Success	Lifelong learning Legacy	Idealistic outlook Inspired to succeed	Narcissism Overachievement Process over product
Generation X (1965-80)	Entrepreneurship Ambition Self-trust	Independence Freedom/Few rules	Loyal to self Adaptable/Flexible Creative	Impatient Challenging authority Cynical
Millennials (1981–1996)	Reliance on technology Eagerness to learn Confidence	To be a hero To make a difference	Confident Team oriented Digitally savvy Multitasking	Reward for showing up Need for structure Instant gratification

Adapted from Mohr et al. 2011 & Elliott 2011.

Through my medical education career, I have been on both ends of the generation gap. A recent experience illustrated one end when a senior faculty member and I failed to connect for a discussion about a new educational program because of our different preferred modes of communication. He left messages for me on my office voicemail, while I had been trying to contact him via our work-based e-mail system. We finally connected when he reached me on my office phone number. Another example of a mismatch in communication on the other end relates to feedback. A couple of years ago, in the core clinical rotation that I direct, a medical student dropped by my office midway through the first week of a six-week course to ask for feedback on how she had done so far. As a Gen Xer whose experience with feedback had been largely summed up by ‘No news is good news’ or ‘Feedback is for when you have done something wrong,’ I was caught off guard by this student’s request.

Another area in which our multigenerational faculty, who range from traditionalists to Gen Xers, complain about millennial learners is in their commitment to the noble profession of medicine. For example, supervisors report that trainees frequently ask if they can leave at five, even when patient-care responsibilities remain. They would say, ‘When we were in training, patient care always came before any personal commitment!’ Also, millennial trainees frequently ask about their assignments and grading rubric, seeming to care more about what grades they will end up with than how much they can contribute to patient care.

The role of technology in the workplace provides another example of how millennials have frustrated their supervisors. Many colleagues observe that students often don’t carry their pagers, and if they do carry them, they don’t respond to them in a timely fashion. In subsequent discussions with students, they tell me pagers are clunky, antiquated devices that are difficult to use. They prefer communicating through texts and other app-based platforms (our hospital, for instance, is piloting ‘going pagerless’ by directing all communication through a secure, privacy-compliant system via a smartphone app). One faculty member has been so frustrated with students using their smart devices (phones, tablets, and laptops) during her lectures that she told me she was considering requiring students to leave all their devices in a bucket at the door before entering her classroom. We have since discussed ways to incorporate those devices in her session productively.

One of the valuable lessons I have learned working with the millennial generation is that in order to maximize productivity and minimize conflicts, old-timers (like us!) need a culture change and attitude adjustment. We habitually assign blame to how the younger generation has changed, how they do not share our values, have the same motivation, or demonstrate the same level of commitment. This attitude actually shows our inflexibility and fear of change, which ultimately does not serve anybody well. After years of listening to millennial learners’ perspectives—combined with reflection and reexamining my own biases and habits—I have formulated three approaches that I find helpful in our workplace because they not only accommodate but also welcome the millennial generation to work together with us toward common goals. These strategies recognize their characteristics as strengths rather than weaknesses.

Focus on inclusiveness

The millennial generation has been described as self-centered and entitled, characteristics that manifest themselves in a sense of ‘centrality despite a relative lack of experience [6].’ Millennials have grown up in a world driven by social media, the ultimate form of membership and participation in social groups. They need to belong, to share their voices and to be heard. My faculty comment that students and residents are very vocal and have strong opinion on everything. What has worked with me is to listen more and without judgment for their perspectives, then pose directed questions about their ideas for change and improvement. I also hold them accountable for their end of the bargain. For example, if they find supervision in clinical areas inadequate, I probe for their suggestions about not only how supervisors can step up but also how they can be proactive learners themselves. Engaging millennials in this way allows them to have ownership of their education and professional development. Another example of inclusiveness: in response to students’ feedback that our faculty talk down to them in traditional lectures, we switched to the team-based-learning (TBL) format, where learners have to do pre-session preparation, take a quiz to ensure understanding of core concepts, and work actively in a group to solve clinical cases. This format not only satisfies students’ innate need for participation and social interactions but also demonstrates to faculty that they do bring something to the table.

Despite their outward show of confidence, millennials also tend to crave approval. Growing up in the age of social media, they expect ‘Likes’ and thumbs-ups as routine parts of any activities. Older generations often dismiss this as the younger learners’ need for a reward just for showing up. A more productive way to handle this might be to think of feedback as an ongoing process, with a beginning, middle, and end. For example, during orientation of my six-week course, I explicitly discuss how, when, and how often feedback will be provided, what feedback will include, how we will monitor progress, and how the data will or will not count toward students' final grades. One could imagine that if I had done this sooner, I might not have encountered the aforementioned scenario in which a student caught me off guard by stopping by to ask for feedback.

Additionally, millennials appreciate honest and open discussions even if this shows vulnerability on either side; after all, on social media, thought processes, attitudes, and underlying motivations are plain for all to see. As a result, I have found myself more at ease discussing examples of how I have learned from past errors and of efforts to improve. When I conduct interdisciplinary family meetings to discuss bad news, medical errors, or family-provider conflicts, I include students and residents at the meetings (sometimes as observers, at others as participants) and make a point to debrief the encounters, including how I had role-modeled (as good or bad examples) and how they might have done it differently.

Leverage social consciousness

As a cohort, millennials are unique in their social consciousness, and they make decisions based on that awareness. Keep them engaged at work by showcasing a culture of paying it forward and tying the day-to-day into the larger purpose of the organization. Kathryn Minshew [7]

As witnesses to 9/11 and its impact on race relations, the Black Lives Matter movement and other world-changing events, millennials have learned to appreciate diversity. Multiple polls have shown that they are generally supportive of equal rights, same-sex marriage, and environmental protective initiatives [8]. They have also exercised their rights to protest against different types of social injustice. With this sense of social consciousness, millennials want to know how what they learn and do will impact society and lead to the outcomes they want. For a recent self-study looking at our undergraduate medical-education curriculum, student representatives suggested ways to strengthen their educational experience in diversity, cultural competency, and health disparities based on race. In addition, as at other medical colleges, our students have a track record of delivering community service: for example, they operate a free clinic providing uninsured, underserved patients under the mentorship of faculty members, and partner with Physicians for Human Rights (http://physiciansforhumanrights.org/) to provide medical screening for refugees seeking asylum in the U.S.

To leverage millennials’ sense of social justice, I have found it helpful to frame goals and objectives for educational activities throughout medical school to how those activities shape students’ roles in ultimately achieving quality of care and patients’ quality of life. Discussing management of patients’ medical conditions is not simply for building medical knowledge and sharpening clinical skills, it’s also to improve patient lives and contribute to the health of communities. Completing an evidence-based medicine assignment goes beyond learning about the Ask-Acquire-Appraise-Apply cycle [9]; rather, it is about keeping us accountable to quality care and incorporating patient preferences into our clinical decision making.

Incorporate technology thoughtfully

Millennials are digital natives who are facile with the internet of things. They actively utilize smart devices inside and outside the classroom. Knowledge has become something available at their fingertips. Conflicts occur when faculty see students and residents engaged more with their devices than with their materials. These conflicts often occur in traditional didactic sessions. Fortunately, in recent years, faculty have become more open to technology in the classroom and workplace. The challenge may be training people to adapt to new tools on an ongoing basis, as popular platforms may change from year to year.

I remember when I first started using an early version of the audience-response system, in which learners respond to questions using individual ‘clickers.’ While most students gave their full attention by engaging with the clickers, some responded with the device in one hand while using the other hand to look through their smartphones or tablets. In response, I abandoned that system and picked up PollEverywhere©, in which learners participate through the use of their own devices, thus minimizing distraction. I have also found it helpful to ask learners to work, either individually or in groups of three to five, on worksheets they can download onto their smart devices. This approach allows everyone to focus on the same materials. In clinical settings, I have started discussing explicitly expectations for the use of smart devices during patient-care rounds, as well as assigning different team members to look up information that would be helpful for patient-management decisions at the bedside. Other formats that engage the millennials and hold their attention include simulation and games. I have used Jeopardy© to teach both medical content and psychosocial aspects of care [10], and sessions utilizing team-based learning, Jeopardy©, and simulation have received the most positive feedback from students.

How I’ve learned to stop worrying and love working with the millennial generation has definitely been a journey full of trial and error. Millennials have arrived, making their voices heard and presence felt in workplaces across all industries. Older folks, including me, need to realize that we must change to maximize our interactions across generations. The first step is acknowledging the strengths of others, and the second is leveraging those positives to reach common goals that benefit all. It is my hope that the three approaches described above will be helpful in your own intergenerational journeys.