2.3 Generational Differences

Each generation has special characteristics brought out by the times in which they have lived, which has affected how they communicate in both reception and expression of information. This chapter examines key differences between the generations and discusses their application to medical education and patient care. Both older generations and younger generations will be discussed.

The Traditional Generation/ “The Greatest Generation”

The Traditional generation (aka Traditionals), those born before 1945, was shaped by the Great Depression and World War II, among other events. They have been described as “emotionally conservative,” and this is one reason they are also called the “Silent Generation” [2]. They tend to be disciplined, more formal, and have a keen sense of duty. Traditionals like to follow the chain of command and prefer to make decisions based on what worked in the past, but they still seek out technological advances. They value respect, stability, privacy, integrity, order, consistency, practical communication skills, and paying your dues. Traditionals are loyal workers who are highly dedicated, risk-averse, and committed to teamwork and collaboration [2]. They want satisfying work opportunities that are stable, and they appreciate the personal touch such as handwritten notes [1].

When communicating with the Traditional Generation, colleagues should understand that a few well-chosen words of appreciation mean more to this generation. Showing respect is important to them. They expect students to work hard, not complain, and not look for a lot of recognition. However, when Traditionals praise someone, it is short but genuine and meaningful [2].

The Baby Boom Generation

The Baby Boomer Generation are those born between 1945 and 1965, although the exact years vary slightly depending on who you are reading [1]. They witnessed and partook in the political and social turmoil of their time: the Vietnam War, the Civil Rights Movement, the John F. Kennedy (JFK) and Dr. Martin Luther King, Jr. (MLK) assassinations, Watergate, and the sexual revolution as well as Woodstock, and the freewheeling 1960s [2]. Baby Boomers grew up in an era of prosperity and optimism, bolstered by a sense that they are a unique generation capable of changing the world.

They respect authority but do not always trust it. Many are accepting of diversity, optimistic, more politically liberal, conflict-avoidant, and relationship-oriented They also thrive on the possibility of change and love a noble cause. They have a fierce sense of right and wrong. Baby Boomers have been described as the “Show Me Generation,” which translates to words meaning little to them and actions meaning more [2].

When communicating with the Baby Boomer generation, one should be dip- lomatic to avoid seeming confrontational. Confrontation can be interpreted as disrespect, which is something this generation will not tolerate well. Since they value actions, students should work hard and point out what their actions mean [3]. Speak up if you have ideas as Boomers enjoy innovation [2]. Keep a higher ground stance and appeal to their sense of right and wrong.

Generation X

Generation X (Xers, as they are known in short) are those born between approximately 1965 and 1980. Gen Xers grew up in a period of financial, familial, and societal insecurity associated with a significant recession. They witnessed their parents being laid off along with the decline of the American global power. Also, Xers grew up with a stagnant job market, corporate downsizing with limited wage mobility, and are the first individuals predicted to earn less than their parents did [2]. They have grown up in homes where both parents worked. This created a “latch-key kid” generation, where they were obligated to fend for themselves. They were influenced by music television (MTV), the HIV/AIDS epidemic, the fall of the Berlin Wall, and their mantra in high school was “question authority” because they felt authority had let them down [9].
Due to their economic hardships, Xers started to walk away from the workaholic lifestyle of the previous generation. They value a balance between work and life and are fiercely independent, entrepreneurial, pragmatic, and creative. They value actions more than words and accomplishment more than money [2].

When communicating with the Gen X generation, be direct and practical. Do not be afraid to share ideas. As mentioned previously, Xers appreciate innovation. Colleagues should show independence and initiative, like looking things up before they are told. Asking thoughtful questions also shows that learners are listening and trying to learn, not just going through the motions or biding time until they can leave. Supervisors, colleagues, and instructors can tell who is really trying and who is not [3].

The Millennial Generation/Generation Y

Generation Y, aka millennials Millennials are those born between 1980 and 2000, depending on who you listen to. Millennials are now the largest generation since the Baby Boomers’ population is shrinking. They are also estimated to make up 75% of the workforce by 2025 [1]. This generation has been shaped by parental excesses, computers, dramatic technological advances, and relative peace. They were raised with close parental involvement (the so-called “helicopter parents”). As children, they were showered with constant praise and therefore may be overly confident [11]. As a result, Millennials are “optimistic idealists.” They value respect, being heard, and dedication, and they want leaders who 6  display these qualities. Millennials hold steadfast to ideas or causes but not as much to people or employers. They value meaning and validation and wish to contribute positively to the world [2]. Due to having increased interaction with technology and less with people, words mean more to this group, and they are more idealistic than their predecessors [2]. Millennials desire a more balanced life than the Xers. They have been characterized as “demanding” because they have a high expectation of those in authority [2].

Generation Y is likely to be more technologically advanced than older colleagues due to exposure, they should understand that the generations before them did a lot more with a lot less of the technological advances that they had the opportunity to know. Millennials should try to respect the contribution of the older generations, just like they want them to respect theirs. If their teacher or supervisor does not e-mail or text them back right away or accept an invitation to something after work, it does not mean they are ignoring them. Older generations are more comfortable with a more distinct set of boundaries. However, if they do reach out to a millennial student by e-mail, text, or phone, they must think it is important, so the student should respond as soon as reasonable [3].

Generation Z

Generation Z or Gen Z are people born around 1995 to 2010 [1]. They are just now entering the job market, so their characteristics are not fully known yet. They are called “digital natives” because they have known technology since birth [17]. Thus, they are deeply attached to technology and expect employers and schools to embrace it. Due to witnessing turbulent times and political turmoil, Gen Z has less trust for authority and believes respect is earned – more like Traditionals [17]. They value meaning and are motivated to contribute positively to the world. Gen Z members are technological idealists and social justice warriors [17].

Their generation is the most racially and ethnically diverse in history [18, 19] They embrace diversity and expect their leaders to do the same. They perceive that the world is smaller because of technology and use technology for communication more than any other generation. However, 72% of Gen Z workers prefer face-to-face communication at work, while 11% prefer texts, and 9% prefer e-mail [20]. Another study found that Gen Z respondents were more likely than technology-obsessed Millennials to value face-to-face communication, emphasizing effectiveness over convenience [21].

Members of Gen Z should try not to stereotype older colleagues as “less connected” or in tune with tech, even though they may be. Generation Z’s characteristics are much more like the Xer’s than one may think in that you both like direct face-to-face communication and value innovative ideas. Learners should try to ask well-thought-out questions.

Conclusion

While this information in this chapter is focused on the differences between the generations, it is worthwhile to point out some similarities as well. Notably, several generations have similar descriptors. However, the magnitude of how much that descriptor applies is what changes over time. For example, Traditionals, Boomers, and Xers all value action more than words, but that characteristic became less prominent over time. While Millennials and Gen Z both value words more than actions, it seems more apparent in Z so far. It is also notable that beneficence is a common thread throughout the generations. It seems wanting to know that we are contributing to the greater good is a universal attribute.

Chapter References

1. 1.Generational differences in the workplace [Infographic]. Purdue Global. Available from: https://www.purdueglobal.edu/education-partnerships/generational-workforce-differences-infographic/. Published 2021. [Accessed June 7, 2021]
2. Tolbize A. Generational differences in the workplace. Rtc.umn.edu. Available from: https://rtc.umn.edu/docs/2_18_Gen_diff_workplace.pdf. Published 2008. [Accessed June 7, 2021]
3. Jimenez S, Ford-Wilcox H. Generational differences in communication and translation to medical education. Osteopathic Family Physician. 2022;14(2):1-4. DOI: 10.33181/13068
4. Medscape E. How generational factors impact patient engagement. Integrated healthcare executive. Available from: https://www.hmpgloballearningnetwork.com/site/ihe/article/how-generational-factors-impact-patient-engagement. Published 2022. [Accessed August 14, 2022]
5. Katie A. Older generations place more trust in physicians than younger ones, study says. Beckershospitalreview.com. 2021. Available from: https://www.beckershospitalreview.com/digital-marketing/older-generations-place-more-trust-in-physicians-than-younger-ones-study-says.html. [Accessed 19 Aug 2022]
6. Heath S. Understanding generational differences in patient engagement. Patient engagement HIT. Available from: https://patientengagementhit.com/news/understanding-generational-differences-in-patient-engagement. Published 2016. [Accessed August 14, 2022]
7. Sathyanarayanan D et al. Telehealth use in geriatrics care during the COVID-19 pandemic—A scoping review and evidence synthesis. International Journal of Environmental Research and Public Health. 2021;18(4):1755. MDPI AG. DOI: 10.3390/ijerph18041755 [Accessed 15 Aug 2022]
8. Heath S. Adoption of patient portals growing in older populations. EHR intelligence. Available from: https://ehrintelligence.com/news/adoption-of-patient-portals-growing-in-older-populations. Published 2016. [Accessed August 16, 2022]
9. Gerber Ben S, Eiser AR. The patient-physician relationship in the internet age: Future prospects and the research agenda. Journal of Medical Internet Research. 2001;3(2):e15. JMIR Publications Inc. DOI: 10.2196/jmir.3.2.e15 [Accessed 19 Aug 2022]
10. Newitt P. Physicians’ average age by specialty. Beckersasc.com. Available from: https://www.beckersasc.com/asc-news/physicians-average-age-by-specialty.html#:~:text=The%20average%20age%20of%20a,to%20data%20firm%20Definitive%20Healthcare. Published 2022. [Accessed August 19, 2022]
11. Levenberg P, Aaron M. The millennials in medicine: Tips for teaching the next generation of physicians. Journal of Academic Ophthalmology. 2014;07(01):e017-e020. DOI: 10.1055/s-0034-1396088
12. Fein K. What’s left of generation X. Dissent Magazine. Available from: https://www.dissentmagazine.org/article/whats-left-of-generation-x. Published 2019. [Accessed June 7, 2021]
13. Anderson E, Buchko AA, Buchko KJ. Giving negative feedback to millennials. Management Research Review. 2016;39(6):692-705. DOI: 10.1108/mrr-05-2015-0118
14. Sherber N. The millennial Mindset. Journal of Drugs in Dermatology: JDD. 2018;17(12):1340-1342
15. Goodwin J. Understanding the “Why” for gen Y: What millennials are looking for in healthcare practices. Mgma.Com. 2022. Available from: https://www.mgma.com/resources/quality-patient-experience/understanding-the-why%E2%80%9D-for-gen-y-what-millennials. [Accessed 19 Aug 2022]
16. Gooch K. 6 Ways Gen Z interacts differently with the healthcare system. Beckershospitalreview.com. 2022. Available from: https://www.beckershospitalreview.com/strategy/6-ways-gen-z-interacts-differently-with-the-healthcare-system.html. [Accessed 19 Aug 2022]
17. Frances T, Hoefel F. ‘True Gen’: Generation Z and its implications for companies. McKinsey.com. Available from: https://www.mckinsey.com/industries/consumer-packaged-goods/our-insights/true-gen-generation-z-and-its-implications-for-companies?cid=eml-web. Published 2018. [Accessed June 7, 2021]
18. Who is Gen Z and how will they impact the workplace. Western Governors University. Available from: https://www.wgu.edu/blog/who-is-gen-z-how-they-impact-workplace1906.html. Published 2019. [Accessed June 7, 2021]
19. Parker K, Graf N, Igielnik R. Generation Z looks a lot like millennials on key social and political issues. Pew research center’s social & demographic trends project. Available from: https://www.pewsocialtrends.org/2019/01/17/generation-z-looks-a-lot-like-millennials-on-key-social-and-political-issues. Published 2019. [Accessed June 7, 2021]
20. Campiere A. How generation Z communicates at work: Ryan Jenkins, Others Weigh IN. PCMA. Available from: https://www.pcma.org/how-generation-z-communicates-work/. Published 2019. [Accessed June 7, 2021]
21. Yozell Associates. Generation Z Values Face-To-Face Business Communication. Yozell Associates; Employee Benefits Newsletter. Available from: http://yozell.com/blog/generation-z-values-face-face-business-communication. Published 2017. [Accessed June 7, 2021]
22. Denison E. Generation Z Research – State of Gen Z™ 2018 – The Center for Generational Kinetics. The Center for Generational Kinetics. Available from: https://genhq.com/generation-z-research-2018. Published 2018. [Accessed June 7, 2021]
23. Sing Sonia IM, Christina IM. The rise of digital natives: How millennials and Gen Z are transforming healthcare – AVIA. AVIA. 2021. Available from: https://aviahealth.com/insights/the-rise-of-digital-natives-how-millennials-and-gen-z-are-transforming-healthcare/#:~:text=Gen%20Z%20is%20increasingly%20dissatisfied,full%20autonomy%20over%20their%20health. [Accessed 19 Aug 2022]
24. Benton TD, Boyd RC, Njoroge WF. Addressing the global crisis of child and adolescent mental health. JAMA Pediatrics. 2021;175(11):1108-1110. DOI: 10.1001/jamapediatrics.2021.2479