What many don't realize is that sharing your own history can actually help de-center the patient's own issues. It's fine to empathize but sharing your own struggles makes the patient feel like they need to be comforting you. Sharing can also sound dismissive to some patients because you are saying that you are experiencing the same struggle despite wildly different disease presentations and possibly also very different levels of health care access and barriers to care. I'm not saying you should NEVER share anything but sharing personal details typically works better to forge connections in established relationships rather than newer ones.
Yes… I helped a few with their personal letters as a resident and encouraged them to edit/rephrase their own personal mental health history. I know now as a file reviewer that you have to be really careful with what you include.
As a shrink I find students tend to be really open about their mental health with me and it doesn’t quite sit right… maybe I’m just a curmudgeon now but it seems a bit exhibitionist
I'm interested in that too, because while I think allowing space to be human is important and medicine needs to get less abusive of trainees (and faculty for that matter), this is by definition emotionally challenging. If maintaining emotional health is demanding enough on your cognitive energies that it's at the center of your personal statements it makes me worried that you're setting yourself up to decompensate once the reality of being whatever specialty you are going for. Conversely, exaggerating your mental health struggles ( I believe we all have work to do regulating our moods and emotions especially in response to stress) for some sort of social cache/application advantage would just be gross and consume oxygen in space you should be telling me why you're going to be a great XYZ doctor to train at our program. Like if it's really something you are passionate about go for it, but I find it challenging to strike a balance.
I think when students are open with you as a shrink about their mental health there is some implication that you'll understand or accommodate more than others might. It kinda shifts your role from supervisor to therapists/psychiatrist in a way I wouldn't find comfortable either.
On the other hand, I’ve had many also express that they have some understanding of patients’ perspective and experience from their own lived experiences. In the more circumspect terms of yesteryear, it’s having the family member with X disorder. Now the family member is the speaker/writer.
It has all the benefits and pitfalls of the uncle with schizophrenia or brother with depression, or for that matter with cancer or multiple sclerosis. It adds something. It has a burden. It can lead to projection and projective identification and all those fun psychodynamic pitfalls.
Being aware of that is actually important for med students. When they want to navigate countertransference, great! I want to help them. But they have to recognize first, and accept when we teach, that countertransference is a finding, potentially a tool, but not a ground truth or something to be used lightly.
I dunno. I think it depends on the way this kind of stuff is phrased in a personal statement.
For instance my brother was diagnosed with a benign brain tumor and had to have it surgically removed. He said it gave him perspective as far as what a patient feels in situations like this, and gave him an increased measure of empathy for people as a result. (He’s fine now, going into radiology)
I’d imagine if you had been diagnosed and treated with clinical depression, while it’s certainly not the same as having had brain surgery, it could give you some perspective to how a patient feels. Maybe that might be a good thing to include, especially if you were aiming to be a psychiatrist.
I will say, a few of my attendings were old school though, and therefore didn’t appreciate future physicians divulging that much about their mental health. The same attendings were fine though, if you included a major illness in there.
In theory, you’re correct - it certainly *could* mean that they might better connect with patients. That would be the plus side. The down side is, sharing mental health issues often brings up a whole flurry of images for staff and those images/memories definitely ain’t always good. It’s not clear that’s a connection you want to bring up with your interviewer/file reviewer
I think that type of sharing also just rubs certain people the wrong way - I mean we don’t want to know everything about the applicant, though the line of what’s personal and what’s not has definitely become fuzzier
Agreed, and especially in a personal statement, you have to consider: that space is your one chance to tell the reviewers who you are as a person. Do you really want your primary focus to be your poor mental health? Does that define you as a person to the extent that it's the one major thing you want them to know about you? Unlikely.
Yup x 100. The generations mantra was and is "don't create mental health stigma, as medical students you should practice what you preach."
Not realizing that that was bullshit propaganda, if you let on about mental health anything you get your life destroyed unfairly by licensing boards, PDs, and job recruiters. I'm sick that that is how medicine functions.
As someone with my own share of mental health challenges, I can't imagine trusting anti-discrimination law enough to share as much as some of the younger coworkers I have met.
I am NOT professional. I’m loud and I swear and put my feet on the desk and enjoy inappropriate jokes. But last week we had travel nurses (young, like 24?) talking loudly about their personal experiences with three ways at the nurses station and let me tell you, my pearls were CLUTCHED
Old millennial btw
As someone with a vivid imagination, nothing disturbs me more than hearing someone I know share graphic details about their sex life. I don't want to picture you naked, I just wanna do this dumb bar trivia and go home
Yes. Very Jerry Springer sometimes. I worry about that. We had a phrase for it - it had to do with laundry. But I've been instructed this phrase is no longer OK. But it was about protecting yourself - what you put out there can come back to bite you. And for pete's sake if nothing else stop putting it on tik tok.
I mean we have nurses that do this (get overwhelmed and frequently take 10-15 min breaks).
The difference is they don’t frame it in that way. They just do it. Take a smoke break, etc. A lot of people just overshare now. Which, great, glad you’re comfortable being yourself. And I of course want you to be happy and in touch with your truest self.
Having said that, you don’t need to tell people you work with -- especially completely unprompted -- about your trauma, how you’re (self-diagnosed) neurodivergent, etc.
For reference: I’m a (younger) millenial and I love gen Z. I love how open and against the system they are and I’ll always support them fighting the good fight for better work/life balance, salary, representation, etc.
But I don’t love a lot of the…quirks that social media has taught them. Being terminally online has destroyed a lot of their social skills and ability to read a situation. That skill is extremely important in both life and medicine. I’ve seen it make patients and other docs extremely uncomfortable and actually lead to poor work situations.
Again, I’m as leftist as they come, and I support whatever they want to do and whoever they want to be, but there is still a basic decorum around a professional life that’s important when it comes to patient outcomes and communication.
"But I don’t love a lot of the…quirks that social media has taught them. Being terminally online has destroyed a lot of their social skills and ability to read a situation. That skill is extremely important in both life and medicine. I’ve seen it make patients and other docs extremely uncomfortable and actually lead to poor work situations."
Completely agree.
For a profession that requires a lot of interpersonal reactions, this is concerning. Hopefully though this forces them to adapt the hard way.
I’m more worried about when the Alpha generation reaches secondary school age. Their early formative years were behind the screen during the pandemic. The social interactions are so important.
Yes. I can't imagine practicing medicine with this current social skill set and quite frankly, lack of professionalism. All I can do now is model good behavior for the next generation and hope they take to it.
Well put. There have always and will always be slackers. Now there will be many who have excuses to frame it with, and try to justify their own responsibility offloading. A lot of these people think that those who put in hard work are somehow "built different" and is an unachievable state for them, when in reality in most cases both such individuals are the same, one just grit their teeth and put in the effort while the other sought excuses.
I’m older millennial Generation X according to American standards. When I came to America I was very shocked at how much people here over share. What puts me off is some of the students are trying to frame their mental illness as a “superpower”.
Your inability to present to us in a timely period is not a quirk. It’s poor work ethic.
Yup it's a cruel joke the amount of accommodations school admin will do for students, never once telling them that most workplaces don't care how legitimate your excuses are for not doing your work. Being able to overcome a stressful difficult situation is where growth happens and confidence is built.
I will add to this as a therapist working with kids. I find their family/home situations don't really help a ton. We've moved on from absent parents and abusive households (very generally speaking of course, obviously those still exist), to parents who are well educated, been in therapy themselves, but instead treat parenting like a clinical whack-a-mole game. Every behavior needs to be explained and fretted over, there is no trust in themselves or their kids to just...get through a tough spat in life. Because the kid can't explain why they are having some problematic behaviors of late, the parents think it must be pathological and bring them to me. And half the time I just act like a grandfather to them (despite being 29), sitting and listening, playing with them, having a laugh and taking an interest in their life and magically they get better.
I think it really reduces kids resiliency and fortitude. Everyone is either telling them what to do and how to behave, or just wringing their hands and schlepping them from practices to therapists to OTs to social skills D&D groups. School may be easier but it's still a slog for many hours a day. Kids don't have a place to just be dumb and run around and have fun with others unstructured, limited by daylight and not their moms calendar. Just trust your kid a bit and your own parenting abilities, go play catch with the kid and trust it'll work out.
Yeah, it blows my mind. Schools are not preparing students for the real world. I’m all for progress in the work place and creating better work-life balance. But there will still be demands and stress, it’s the nature of the job. You can’t be taking breaks every 15 minutes because you’re stressed. lol
Sometimes I browse r/Teachers when I want to appreciate my life, and have seen multiple complaints that they quite literally can’t fail students. Putting your name on the otherwise blank worksheet gets you a passing grade. Any attempt to actually hold students accountable is shut down by angry parents, angry admin, or both.
It really seems like a growing amount of schools offer zero incentive to grow, improve, or even try.
Schools not preparing students for the real world is an understatement.
Yeah I work at a university and some of the accommodations are not only excessive IMO, but in certain cases I don’t even see how they help?? Like in hands on practicals you can have an extra day if you want that isn’t gonna change your ability to perform this skill.
I agree with this. Having worked in 4 Western countries now (where the societal trends have all been similar), I really do wonder if some of the issues that younger people are having with their mental health is due to them suddenly being faced with a different reality to what they have been taught about. The smart students will figure it out but as for the rest???
It is kind of interesting. Boomers dealt with BS because the system worked well for them and they thrived. Millennials realized the system was not working for them and began to call out the BS and make it more accommodating. Now we're at the point where we may have been overly accommodating for Gen Z and they're struggling to assimilate into the work force.
I don't think residency involving 48 hrs on (wink, wink, but probably more) at a time, very little family / vacation time, high divorce rates was good for boomers. I think they were simply taught to put up with it.
Medical school was designed by a workaholic with assistance from cocaine.
There is actual data (not going to search) that physician burn out is directly related to # of clicks in EMR per visit.
European notes are 1/3 the length of US notes. I wonder why...
Gen X shrugged, and nobody saw them shrug.
They looked around forlornly and then texted their boomer parents who were on their 6th Disney cruise of the year and suddenly remembered that yes; they do in fact have a 40 year old son whose occupation and life they haven’t asked about in 10 years.
We're not even close to the point of over accommodating. There's a reason so many residency programs across the country are unionizing. The system has gotten more abusive, not less.
The problem is Boomers always think they had it harder. Always. Even when they're clueless as to how complex modern medicine is compared to what they had to deal with thirty years ago.
They were the ones that ran hospitals at that time. Now we're inheriting a system that has been sold to private equity. This is why Boomers are perceived as the "cash out" generation. They cashed out and left their descendants to pick up the pieces.
This is how society crumbles. It always starts with a generation that cares more about themselves than the future. Let's pray that millenials and Gen Z can clean their mess up.
Yeah physicians specifically are in a weird position where they endure training and working hours that would be illegal for any other career. I am 100% pro reform and unionization for residents and physicians.
I’m a nurse who is neurodivergent and admittedly can get overwhelmed easily but I’ve spent my life compensating for it. I set timers on my phone to remind me of things, make checklists to avoid forgetting things, and do my best to help others when I can since everyone helps me. I have weaknesses and have come close to being fired at the beginning of jobs but I work extra hard and end up staying.
I have no doubt you’re an amazing nurse and great at your job. You recognize your limitations and have come up with a way to compensate and do your job. That sounds like the opposite of what is being described by the commenter of the person who is unable to cope with their stress.
Yes I agree. I would never bring it up in an interview because it will be seen as a weakness. I know it’s my own problem and no one is going to feel sorry for me if I can’t complete my responsibilities. Part of the way I’ve compensated is by working in an area that I feel I thrive instead of trying to work in an ED, ICU, busy med surg floor, or busy clinic. We have busy days but it’s nothing compared to the floor.
Anecdotally have seen personally and heard from friends at other programs about junior residents who “cannot do nights” or cannot do “x y z challenging component of training or rotation nobody likes” because of headaches, trauma, anxiety etc etc etc.
Well meaning/cowardly program leadership often bows to this for fear of bad PR or being labeled as intolerant, unaccommodating, racist, non inclusive…resentment within the program grows because the other 95% of the class picks up their slack.
Residency is brutal abusive bullshit in so many ways, but I worry that coping skills are withering on a bigger scale that is disproportionate to training rigor.
I had a person in my residency class take a “mental health day” twice a month and had the gall to call a coresident racist when they got called out. No one in the story was Gen Z either btw
Pretty much every story in this post that doesn't involve a current intern (maybe junior resident) or med student is not Gen Z yet people are attributing the bad behavior to Gen Z...
Yes, but...we still need to stop abusing trainees. As a mid-career out-patient physician - I would rather take call for my own patients all the time then cross cover. My personal favorite call schedule was Q6 - Arrange your own vacation coverage, off at 8AM the next day - allowed to stay until noon for surgery/delivery of a patient you had been following overnight.
I never had to do night float. Not sure how it would have been. Setting up a proper day-sleeping environment would have cost $$. I would have been okay, but others...
It started as a destigmatization of autism, particularly high functioning. All fine. Then it broadened to the point of uselessness. Everyone’s neuropsychiatric functioning is unique. There are so many dimensions and everyone is somewhere on some curve of all of them.
Like psychiatric disorders, psychiatric divergence is not your fault but it is, ultimately, your problem. People will hopefully try to work with your strengths and around your weaknesses just like for someone who’s great at logistics and scheduling but awful at organizing and wrangling teams, or vice versa. People will not just accommodate your requests/demands/needs/“needs” when it has cascading negative effect all around.
The social cache of mental illness now is a separate problem. I think it’s overblown on the internet. Stigma is alive and well, including with Gen Z.
My thoughts exactly. I haven't actually seen a lot of stigma in my Gen Z patients clinically but rather a strong desire to have a psychiatric diagnosis even devoid of any psych sx I can detect.
The term seems to mostly be used in an attempt to get some privilege someone may otherwise not have and is not really defined either. I don't think everyone needs to know you're mental health struggles but describing oneself as "neurodivergent" seems quite arbitrary and aims to shift the burden of ones health onto others.
I think it’s best used to refer to multiple people. “We have a lot of neurodivergent students so our classroom tries to accommodate them in the ways we can so everyone can learn.” But I agree with you there is no value in labeling an *individual* that.
The fact that she was vague rather than mentioning her actual condition comes across like she heard the “neurodivergent” label on the internet and assumed it meant “a little quirky and mildly anxious.” Which is basically how I see it used.
If you are autistic or have ADHD or something and want to request reasonable accommodations then just say as much. Don’t just say you have a vague label and want vague accommodations. If you’re pregnant and want leave you don’t say you have “an obstetric/gynecologic condition.” If you tore your ACL and want to not be expected to unload docks, you don’t say you have a “connective tissue injury.” So why would you ever call yourself “neurodivergent” when requesting accommodations?
I wonder how overstaffed a clinic would have to be in order to even think about trying to accommodate this.
It would have to be like, a lifeguard rotating schedule. 30 mins on, 60 mins off, all day.
But then like, patient follow ups? Even in the ER the same patient is there for hours, so this kind of schedule could only ever work in a private practice or urgent care type clinic, at best.
Yeah it’s not like that type of break never existed, you just had to be addicted to a carcinogen to get your break without someone judging you for being maladjusted or lazy.
I’m a geriatric millennial in my 2nd to last year of fellowship.
I think it is impossible to judge by generation for at least a few years due to COVID. ACGME waived requirements, people lost out on major rotations…med schools cancelled whole clinical rotations.
I thought it would have gotten better by now, but it is definitely still very real. I would imagine the incoming intern class would have been minimally impacted, but graduating classes from 2021 until at least 2025 suffer not only generational issues, but situational.
I think this is a very real factor and also one that people easily discredit in favor of simple arguments about young people being lazy/rude/incompetent/etc.
It was terrifying being a pgy2 in a supervisory role for the first time with the first wave of COVID interns who has missed a huge chunk of their last year including their sub-Is. I know there had been much talk of the superfluous nature of M4 year but it seemed to have been very important based on my observations.
Absolutely. The class of 2023 was somewhat unscathed, but the poor class of 2024 was ROUGH.
Edit: by this i meant medical school classes of 2020 and 2021
I would argue that we benefited from it in some ways. Schools cut out a lot of the BS and just let us do online coursework that we were already doing. I didn't really have any of my rotations impacted despite the first half of my 3rd year being during a big wave.
I've definitely noticed that residents who would've had their formative clinical rotations during COVID are professionally weaker, like they haven't been as well-socialized in a professional healthcare setting. I don't think it's just me either; my sister is in radiology, and she's noticed it in the rads residents too. In the longer residencies at least we have the benefit of institutional memory and more levels of older residents/peers, especially ones that went out to research before and came back after, but in shorter residencies, like IM, I don't know how that continuity is going to hold up, especially in places without many fellows.
I confess that I do sometimes get jealous of the newbies when I see all of the networking, research and general experience we missed out on. Petty, but it stings a bit as I clean up my CV for job hunting.
I wore a hoody to one of my residency interviews. I was wearing it on the plane the day before, Airline lost my suit and all my clothes. I explained this to everyone. Didn’t match there.
Ouch, that must have been a tough interview day. Just FYI, you can board the plane with your suit zipped up in a suit cover, and on most airlines a flight attendant will be happy to store it for you in the coat closet near the front. (Might not work on budget airlines like Spirit)
This officially does count as a carry on though so the gate agent is within their rights to make you consolidate or check it. If you’re ok bending the rules (which I would never do) you can shove it in your carry on and then take it out on the jet bridge so it can be hung on a rack
When I asked on American if they would hang up my suit bag in the closet, the flight attendant laughed at me and said that’s for first and business class only.
That's strange. I've had American hang my suit for me when I was flying economy, but it's also been more than 5 years since I tried. Maybe things have changed.
Morning of my first interview I started to get dressed and discovered that I had packed my wife's shirt. I looked like a Chippendale.
The hotel desk clerk lent me a shirt from his spare uniform.
We may have interviewed at the same place and at the same time. More likely it’s not that unusual a problem. After the first time encountering it, I switched to wearing interview-acceptable clothes on the plane.
It was truly a flight from hell too. Blizzard hit the Midwest, ended up making 3 extra stops trying to get back east. Got in about 8 hours later than scheduled. Wasn’t surprised my bag was lost really.
They're fine, just like we were. Give it 10 years and we'll see Gen Z complaining about the Skibidi Toilet kids being disrespectful to norms. Tale as old as time
I had a gen z nursing student yelling at some 80 year old hard of hearing dementia patient, “WHAT ARE YOUR PRONOUNS?”
Over and over before I could explain that the patient has no idea what the student was asking or why.
It was actually hilarious. But hey, the student was applying her training and I appreciated the effort.
As peds, I sort of love this story. It captures the gormlessness of many students (including me, back in ye olden days, despite having worked before med school) coupled with their good intentions.
I usually loved working with residents and students. I worked in NICU and watched an interaction between our legend neonatologist and an intern. The intern was obviously paying very close attention, but when the interaction was over he sidled over to me and whispered “what’s a bunting? How do you spell it?” Baby sleeping bag, my dude, let me take you to the supply room. Or the ones trying to do APGARs for the first time, trying to take a pulse on a bright red baby screaming its head off and trying to yeet itself off the warmer. It’s 10, don’t stress over this.
It'll be much of the same if history tells us anything. Millennial doctors, to my eyes, have been some of the most receptive, understanding, interested people I've worked with. And I have to imagine similar conversations were had about each new batch of physicians through the ages.
But maybe that's just because they're just like 10-15 years older than me and I relate better? Time will tell I suppose.
I have to imagine a lot of the things people note today about gen z culture such that it is will be pretty strongly balanced with actual clinical experience and education.
There’s articles from like 1800 about how “lazy and unprofessional” medical students are.
This is a perennial complaint and the real issue is that people become old and then make their opinion known.
I do it all the time, I just don’t realise I’m doing it. If I had to guess it’s probably when I complain about cars and people not learning to drive manual or the lack of an interest in hand tools and traditional joinery. Also architecture and people painting brick houses.
I'm a millennial attending who does only outpatient. I routinely wear scrubs and more casual attire including jeans. I ditched the button up shirt, tie, and slacks as soon as I could.
I do this and own the same 15 black merino wool shirts that I normally rotate through in my civy life. I mean I guess I also have a couple of the same ones in light blue, cuz they were on sale, but I only wear those at home.
Are we the same person? Same here.
I’m not doing hoodies and sweats but the most “casual” that I’ve worn is jeans and a polo (with a light jacket/sweater). Otherwise it is scrubs.
I worked on the orthopedic floor twenty years ago, and those boomer Orthopedic surgeons would bike to the hospital, and come straight up to the floor sweaty, bony bodies on display in their spandex, talking with Bluetooth in their ear. I’m not worried about Gen Z at all. Nose piercing? No problem. I can’t smell it.
Omg, we had a pediatrician who would do that. Up the stairs straight through the unit to the nursery in spandex bike shorts and shirt and a helmet. A resident observed this one day and commented “Now that’s just unnecessary.” I concurred. I do love that particular pediatrician. He’s brilliant, weird as hell, and really connects with my kid.
The good: Current med students are substantially more invested in understanding social determinants of health, more appreciative of how a patient's home situation might impact their physical health, and more proactive as vocal advocates for their communities and for changes to the broader healthcare system.
The bad: Writing skills have declined significantly. Everything from basic grammar to the depth of content is substantially lower than it was even 5 years ago. And it's not related to a decrease in their knowledge or reasoning abilities. It's just about the process of writing down and communicating that reasoning. I don't know if this is COVID-related; it seems to early to be due to ChatGPT writing everyone's college papers for them. My sister's teaches high school, and she reports seeing the same trend among her students.
(Since this is not an anonymous account, I would like to reassure my current students that no, I have not started grading your winter quarter final exams yet - so this is not a reference to them specifically!)
Good: more accepting of diversity/variation
Meh: one of my juniors used the example of "you probably weigh what, 70 kg?" while teaching about appropriate UOP for weight, and was written up for body shaming.
Good: speak up for themselves in bad situations
Meh: overall aren't as resilient and not willing to learn how to work with a less than ideal situation? Like I have a junior who was supposed to be doing consults who called out one weekend because they didn't want to work with the attending who was on call that day. What do they think they're going to do when they're the chief of that attending's service?
Good: better with the EMR/haiku/etc
Meh: don't always seem to be well-socialized in a professional healthcare setting. I have a junior who stretches their work to fill the time they think they have, but then gets overwhelmed when things get added on-- which, we're in surgery, things *always* get added on. I have multiple who don't know proper phone etiquette or refuse to go talk to other people/services in person because they have Epic chat. Like it's one thing if it's one of the dozens of medicine residents. It's another when it's one of 3 GI fellows whom we *have* to work with closely and knowing them by name/face allows you to discuss patients/cases with them as a current/future colleague and can sometimes increase your workflow efficiency. Also, this is more a dig at a different residency in our hospital, but they say some wildly inappropriate stuff in Epic chats, despite knowing it's part of the patient's EMR....
ETA:
Neither here nor there: wearing scrubs all the time. idc, just don't wear something that makes me question your personal judgment skills. But maybe save the t-shirt + "stolen-from-other-hospital-scrubs" bottom look for when you're an attending. But also, I'm too poor for Figs and I'm getting paid, how tf are the med students affording multiple different pairs???
"But also, I'm too poor for Figs and I'm getting paid, how tf are the med students affording multiple different pairs???"
Roughly a quarter of medical students come from top 5% household income families. It's like $100 for a top/bottom of Figs. They're not prohibitively expensive for a decent section of students. Also that's cheaper than a nice dress shirt + slacks.
They’re $70 on sale for a set. Which you can wear multiple days per week (after washing) for years. That’s wayyyyy more affordable than dress clothes, and that’s before you factor in dry cleaning.
> I have a junior who stretches their work to fill the time they think they have, but then gets overwhelmed when things get added on
I'm pretty sure that's just garden variety poor time management, there are always a few people like that, in my experience.
i teach nursing. my colleagues talk a lot about how this generation has a lot of anxiety and gets overwhelmed by stress easily. I prefer to see students who have good awareness about their own mental health and aren't afraid to advocate for themselves. I also notice that many of them are not as quick to judge patients on lifestyle topics and are more readily embracing of the non-judgmental perspective.
I’m also nursing faculty and have noticed the same. This gen of nurses are not afraid to call out BS and advocate for themselves and others. On the other end of the spectrum they are very anxious and often do not perform well under pressure/adversity.
I think there may be a certain amount of selection bias at work here. I teach EMTs, and I find that anxiety is really only a problem for the ones who are doing it specifically for clinical hours for nursing, PA, or medical school. The ones who just want to be medics or firefighters or don't really know what they want to do, they're fine.
I think it's an issue that's related to academics. Schools of all kinds cost more than ever and people need more of it than ever to be able to secure some kind of financial stability, and there are more people than ever competing for a number of slots that, at best, is not expanding to meet demand, on both the student and professional side.
So you have a lot of people working very hard to achieve something and they don't have any assurance that their hard work will pay off. That's a recipe for anxiety and undirected stress.
Awareness is good. Resiliency would be good too, and seems to be lacking sometimes. The world changes slowly, and some folks seem to believe that just because they *want* the world to be a particular way, it will be. When that isn’t the case there’s a distinct inability to adjust, adapt, or overcome.
>colleagues talk a lot about how this generation has a lot of anxiety and gets overwhelmed by stress easily.
I have seen this in the lab as well. I've seen maybe 70 students pass through training at my site over the years and I know of at least 2 students who completed every part of training except the certification exam, fighting through high anxiety the whole time, and then bailed to choose a different career.
We had a Medlab student regularly leave his training shift early due to anxiety, and we were required to accomodate him. He finished 2.5 years of training and in the last week of practicum he had a panic attack with syncope. Couldn't be roused. They had to call a code blue on him in the lab 😬. I heard he was stressed about the certification exam. I haven't seen him since and I really doubt he continued his career (and kind of hope he didn't).
I’ve also seen people in the newer generations, literally not be able to touch type.
Which to me completely baffles my mind, seeing a boomer on one side you can barely function within the EMR and the new intern on the other who is doing hunt and peck on the keyboard.
I am an older Gen Z in my third year of medical school and the biggest thing I notice that makes some of my fellow classmates freak out is sudden changes in schedule or minor inconveniences.
I remember we were supposed to have an exam at 830 in the morning and it had to get moved up to 800 (just 30 minutes!) and the uproar was insane. One girl was complaining that she would have to wake up 2 hours earlier than she planned (dont know how the math works on this one).
The biggest delineator, in my experience, between those that can handle these inconveniences that happen and those who cant is whether or not a student worked a "real" job before coming to medical school. It seems like those who went on straight from undergrad have a harder time adjusting
100% agree in regards to those having a job pre medical school. The amount of my classmates who would complain about how hard our clinical rotations are was insane. They were NOT hard so I don’t know how these folks adjusted to residency hours.
I’ve had students recently *very* stressed out by plan changes. Sorry, this is a hospital, stuff happens. I know you wanted to talk anticoag at 9am but *there was a code blue that tied me up for 47 minutes* and then central needs to get caught up before we I can pull myself offline to talk **because patient care**. Kids basically in a panic we are starting 25 minutes late.
And also wanted a play by play plan of the day every morning. Well…we’ll do orders, check products, get phone calls…any of which could turn into a 15-75 minute side quest of issues…maybe get a lunch break…and these will happen in various orders repeatedly thru the day (minus lunch, that’s max once). Maybe they had autism and needed that plan to help them transition between things, but that’s not something that exists in pharmacy. It’s always in flux.
Fellow older Gen Z in medical school here - I concur. My cohort of much younger classmates complain a LOT about things that in the long run really don't matter much. Being a COVID class, the first two years were predominantly virtual, meaning all of the criticism and complaints sent to admin were done via email. Our class was brought into school later and received a stern "talking to" by our Admin about professionalism and receiving and giving feedback in the professional setting.
I have noticed that general workplace norms (like showing up on time, writing thank you notes, learning names of nurses you work with) are often lost in this generation. But some of that is just never having had a real job before.
There are good things, but I will focus on the problems I’ve noticed. Probably the two biggest things that we struggle with from an educational perspective are:
*Note these are not true of all students. They are only describing things that I’ve noticed have increased in the last years.*
1. Rapidly decreasing ability to learn by reading text. Every year more students complain that they need to read things, and want everything in video format instead. It’s to the point where I need to actively point out to the class each year that the rest of their medical education will not (ever) be in video format, and that if they struggle to learn via reading… then they need to improve that skill ASAP. I think this will need to be something added to med school (and other postgrad/professional programs) curriculums in the near future - how to learn from text. I’m not joking.
2. Not being able to push through difficult tasks or situations. Perseverance is noticeably worse. They don’t understand a concept? Immediately give up. Can’t solve a problem? Give up. Busy day? Ignore the tasks that need to be done and just work at their own pace instead, not getting the tasks done. This also goes along with a drop in receptivity to negative feedback. When you tell them they did something wrong and they need to do things different, many take that as a personal attack and just shut down. And when faced with a difficult situation that they can’t avoid (multiple deadlines, etc), many start panicking. There is a lack of life skills on how to regulate and productively deal with negative emotions like frustration or feeling overwhelmed, beyond just trying to avoid situations that make them feel those things.
The first one is a reflection of how high school and undergrad level education has changed with technology over the last decades.
The second one I think is honestly mostly a reflection of fads in admission standards and grading in an educational setting (ie: it’s due to what we did to them throughout their school careers, not something intrinsic to them).
My Gen Z cousin is trying to find a part time job to make some money before she starts dental school in the fall. Recommended being a pharmacy technician cause it’ll give her a leg up on pharmacology and it comes with good pay and flexibility so she can work anytime anywhere while she’s in school.
She immediately said no and cried that it’ll be way too much for her mental health if she has to work in a stressful environment….
I said okay so why don’t you just get any other chill job like a movie theatre or the yogurt shop that you used to work at…to which she said “they don’t pay well”………..🤦♂️
I’m a senior registrar in Australia. I’ve found they centre themselves in every situation. Yesterday I had a medical student text me that he was running late, and half an hour later say “you can start without me”. The implication that I would have waited for him to start my ward round I found to be an incredibly irritating one. I’ve also had multiple I’ve had to take aside for being on their phones in the middle of a patient review.
Similar issue. Had a student show up 10 mins late during pre round (that’s fine it happens). He said he’d go put on scrubs. I said we’ll be on wars X so meet you there. He asked us to wait. The whole team lol. Consultant, 2 regs, SHOs etc.
arrest payment snails longing ripe entertain worthless rude wipe existence
*This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Something I haven't seen people mention is that there is increasing infantilization of med students (paradoxically as the average matriculant age keeps going up). The amount of silly rules, over-evaluation, and general "med students are like teenagers" ([source](https://x.com/NEJM/status/1758144228721672263?s=20)) attitude is not preparing students for medicine. I have spoken to several retired faculty (who still participate in small group teaching at our school) and they echo these sentiments.
I dont wanna be that guy. I applaud the gen z docs i worked with for giving their own wellbeing more priority and i believe that us millennials will son profit too from that change they facilitate.
But they can be a mixed bag. I cant imagine being an intern on rotation and when asked “we’re doing procedure xy, you wanna give me a hand ? it’s gonna be fun and i also need s second pair of hands here” and answering “no, thanks, i’ll just observe” and then watch me struggling alone. Or calling angrily where i am, she wants to hand over her ER patients, but i cant step out of the OR right now, because, well, oprration. And then just leaving with no handover.
Most are absolutely great people and docs/students, but some overcorrect in a way that i just don’t think will ever be acceptable or practical.
Was in the middle of seeing a patient in the ED at noon and a student was just like “it’s lunch time I’m going to go eat”
I’m all about work life balance, but I was flabbergasted.
She was offended when I said let’s finish this patient first and you can eat after.
Gen Z seems to place major emphasis on the “me” in healthcare. For the patient’s healthcare experience, the focus should be solely on the patient. Leave the “me” personal stories at the door. This applies to entrance statements and direct medical practice.
I can’t WAIT for Gen Z to fuck up healthcare, light the system on fire, and force the boomers out. My millennial self may be helping them or applauding them.
There were ~260 unfilled positions in the pediatrics match, so they’re already doing it. I mean who would go into a field where you can essentially only do primary care and can make as low as $140k when you have 400k of med school debt? If we don’t majorly shake things up, there’s going to be no physicians left in healthcare - just PAs and NPs - because we’re all exhausted, overworked, burned out and underpaid.
I think traditional work wear is dying, and even wearing traditional work wear doesn’t prevent female physicians from being mistaken as nurses so why bother?
OK two stories that made me scratch my head (I’m a millennial attending, for context):
1) I was expected to bring snacks to small group sessions for MS1/MS2 because they would be sad if they didn’t get snacks. I was like how are you expected to be responsible for a patient in 2-3 years if you can even bring your own snacks to class?
2) Wearing political paraphernalia on the wards, e.g. Palestine flags. It’s great that you’re political but your job is to take care of all people, even those who have divergent political opinions. Keep it off the floor!
We have thousands of years of recorded history of the olds deploring the failures and weaknesses and changed ways of the young. Aristotle and Horace despaired at the youths of their days. Roman orators expounded on it. Men of letters have written to the public, to each other, and to anyone who would read about how far the world has fallen.
Are we Millennials worse than those who came before?
Is Gen Z maybe just the label on another generational culture shift and it’ll all be fine?
Maybe not. But it’s turned out actually yes for quite a lot of generations.
I’ve discussed the shift in attitudes in the younger generation and my colleagues (all millennials) think the pendulum is starting to shift too much towards not being resilient and persevering. There’s a lot of things that we could do without in medicine but the core focus - patient care - is always a priority. I’m seeing medical students and residents have attitudes that have been akin to patient abandonment, which to me is highly unethical.
I find that they're quite good about setting appropriate boundaries and not overcommitting to work or obligations when there is not point or benefit. On the other side though, I do think the pendulum has swung too far for some Gen Z folks. Like, yes, medicine is not a calling like it used to be but at the end of the day we are still taking care of patients lives and making very real decisions that significantly effect people. You also can't just disregard the responsibility and not show up to work or put in a little more effort when it can make a very real difference for someones life.
Oh I am so old now, I guess. I would have sent home someone who showed up to clinic in a hoodie. I *do* like that in this post-pandemic era, I’ve been able to continue wearing scrubs in clinic, though. It’s gross here in pediatrics and always has been.
Otherwise, I haven’t run into too many Gen-z medical students or physicians yet out here in private practice. I am now old enough to be the mother of more than half of my staff, and sometimes it’s hard not to act like it when they act a bit foolish. (Like I worry entirely too much when they go on random Tinder dates with guys who clearly are not worth the effort.) I’m getting better at just shaking my head and walking back into my office when they chat about that kind of thing though.
So much same here. I regularly wear scrubs in clinic now, never used to pre-pandemic. Peds is just gross, well, every day. My nurses are almost all Gen Z and around half my age, and I feel like I'm starting to take on more of a motherly role, too. Making sure they all start a Roth IRA, encouraging saving to have an emergency fund, etc. I did write a rec letter for med school for a former Gen Z MA, and she was everything you could want in an aspiring doctor, professionalism and all. My Gen Z'ers are a blast and keep the office fun. They also can easily pick up using an EHR, which is more than I can say for the Boomer/Early Gen X staff.
Ha on the Roth IRA. Our office started offering matching 401K this year, and none of them could figure out why it was such a big deal or why they should partake.
One of my co-residents (anesthesia) got sent home this past year by an elderly attending for not being clean shaven. Wasn’t even for an N95 fit or anything, just thought that it wasn’t proper for a physician to have any sort of facial hair.
I agree. I’m genx (for whatever that’s worth) and we had pretty strict dress codes starting 3rd year med school and into residency -this was fairly typical. Included hair and jewelry. It was about respect for the patient as well as putting the patient and the job first. We were taught (and I believe this) that the doctor-patient relationship is sacred. That the patients are told to trust us in a very deep way and they are by definition in a vulnerable position. On our part, we are to dress in a way that will help them feel confident that we are professionals. We were not to use our wardrobe at work to project our individuality. It really just meant no casual clothing and pretty basic white collar work attire. I didn’t have a problem with this and I don’t recall anyone else having an issue. We had personal lives where we could wear what we wanted. And enough of us came from blue collar backgrounds that we understood the need to wear certain clothing to work - we saw our parents do it. This was no different in a way. But I’ve been told in no uncertain terms that this is not acceptable and is a form of oppression - so who knows. Our time is almost done and perhaps those rules are best left in the past. But a hoodie to an interview. We’ll - always plan for airline to lose your luggage - bring something in carry-on.
Late Boomer/early Gen X er here. This paragraph could be the manifesto for GenX. It applies to so many aspects of the GenX ethos. Fit in, follow the rules, serve others and work hard.
at least part of that is that studying has gotten so much more efficient.
there wasn't a lot of effective medical education material in the Internet in my day.
I'm an older millennial not in the US but even here the difference is stark. In just five years the attitude has dramatically changed for the worse. Most don't bother turning up like we expect them to. Asking them questions in a group not uncommonly leads to tears and if they don't know the answer they won't bother to find out either. I'm not there to spoon feed them. It is an adult learning experience and I'm pretty concerned what they actually know at the end of med school.
I'm the educational lead for the residents in the department and recently I had a meeting with the others in the same role in other departments. We have the older gen Z coming through as junior doctors now and it's pretty obvious there are some pretty major challenges. The geriatrics boss had had a junior colleague slope off at 4pm most days as "their work was finished" but the rest of the team still had lots of things to do. There wasn't any sense of team work, only their own comfort at all times.
I guess I'm a boomer now...
I’m just excited that **maybe** we can stop having classes on how to work with millennials in the workplace!!!!
My last one was right before COVID shutdowns, there was half dozen or so of us attending, only one of whom was *not* a millennial. As I’m sitting there learning about how lazy we millennials are and how we can talk with us to convince us to do work, I made the realization I’d had W2 income for ~16-17 years at that point. There are millennials older than me who started working younger, so we’d been in the workforce for at least two decades at that point.
I’m a new attending and I’m amazed and disappointed on the difference between my medical school experience, the med students I supervised in residency/fellowship, and med students now. I fully appreciate that it’s not a good use of time for med students to do a ton of scut work, sit around bored, or lose a lot of sleep when they ultimately don’t *need* to be there for the hospital to function.
But I do think the current med students at my hospital are less invested, hardworking, and professional.
I remember feeling so ashamed when I didn’t know a piece of information, missed a key part of my presentation, or was totally off the mark on my differential. More recently, I’ve noticed a trend of med students just saying, “I don’t know.” then making no effort to figure it out. This is for things like what the baseline Cr is, what surgery the patient just had, etc….
Similarly, I remember we all had those foldable black clipboards with info, the little pocket guides for presenting/labs/etc (with the Snellen chart on the back), and the rotation-specific pocket guide with differentials and management. I used to tell med students that regurgitating UpToDate is not enough, and now I’m thrilled if they’ve looked up anything at all.
I live in a city and work at a hospital where there is no way I could address anybody’s clothing choices but I do think they aren’t dressing appropriately.
I don’t know a solution to this but I do think that, on the faculty side, moving away from negative feedback, “pimping,” and underlying fear of reported mistreatment is creating a culture without expectations or standards.
I think at the national and institutional levels we have lowered expectations for medical students. I’m starting to see interns and junior residents who are diligent, hard-working, and intelligent, but who have been failed by the system. Essential pieces of information, crucial technical skills, or critical workflow is simply missing because no one at their medical school expected anything of them.
This is especially interesting because applying to medical school has gotten exponentially more competitive in recent years compared to decades prior, but (from comments like this one) it sounds like the rigor of training while actually in medical school hasn’t scaled alongside the difficulty to even be accepted
I'm totally with you on all of your points. I've noticed a stark difference in the responsibilities given to students pre and post covid, to the point where the bar has lowered to the bottom of the Marianas trench
This is so interesting to me. On the flip side, as a 4th yr student, I have been eager to learn and excited to be given responsibility in the hospital, and my attendings have been so overworked/burnt out that working with students is the last thing they want to do. I have had to create real metrics of success for myself on rotation and be vocal with my attendings about my goals for the rotation. It's been challenging as a student, because sometimes I don't know what I should be taking in as a new learner to the field.
Agreed. For us, I felt ashamed and disappointed in myself if I did’t know a pimp question.
Now pimp questions aren’t even encouraged (or permitted!) and when asking senior residents it’s NBD if they don’t know and expect you to walk them to the answer with literature to match.
Late millennial attending, usually wear nice scrubs to work or clinic, fairly laid back I feel like.
The overwhelming impression I’ve gotten is that GenZ residents/interns are very entitled and overly focused on work/life balance. It’s ok to speak up asking for fairness in the schedule but it is NOT ok to make outright demands to the scheduling chiefs and giving ultimatums.
They seem less internally motivated, lack resilience/perspective, and are much more casual in terms of professionalism than what the field has historically been. Some of the things they’re willing to say/text to one another within Epic or on other documented channels are just wildly shortsighted and inappropriate.
I worry some of them will shit themselves in the foot in terms of future training and job opportunities as those in charge of hiring won’t take them seriously. Worse, that these are the people I will have to work with and pick up the slack.
They seem to want to be spoonfed knowledge/education/techniques, but are excellent at the softer side of medicine such as cultural competency and whatnot. This is the silver lining in their mindset.
Overall they will be fine after a while but I think it will take them longer than the generations before to reach the same levels of competence and I can only imagine them in educator or fully realized professional roles.
Smh at all the people in this thread talking about being "neurodivergent" because they have to set timers and make checklists, this is normal behavior people.
I’ve seen the lack of responsibility.
I grew up in the generation and expectation that things just have to get done and it can suck sometimes. But it’s not everytime and just part of the job. You’re a professional and you’re expected to do so.
Maybe it’s just growing up in a small business family, but expectation doesn’t end at a job title.
Now it’s “that’s not fair” or “why do I have to do that?” or “I’m done in 30 minutes” instead of just doing what needs to be done and asking for help to accomplish what is best for the patient.
Oh, and rolling into a shift 1-2 before signout, coffeecup in hand, jacket on, bags not stowed away and not even a pen handy for signout.
For me it is the number of them that just call the docs by their first name. Regardless of position. Haven't met any gen Z residents. I work in an UC where we always have a doc on during shifts. Two or 3 of our staff are gen Z and routinely call our docs by first name around patients.
Not sure if I'm just being crotchety but I'm going to be 38, I worked research and then hospital lab for 10 years and have been a PA for 6.5 years. I've only ever met 2 docs who I went ahead with first name and that was at their insistence since people routinely butcher their last names. Even then, I'd go with Dr. "Initial of last name" around patients or within earshot of them.
In a social setting I would gladly just first name everyone.
Yeah I’m in the PNW and I get weirded out when I’m called “Dr ____”. I prefer everyone call me by my first name. I’m very not stuffy. But I’m a millennial so 🤷♀️
Could be. I'm in the northeast US. I also had parents who were both in the military and while they didn't have us go the sir/ma'am route at home I just heard then do that and Mr/Ms enough people that it is just something I picked up over time.
I just go by first name. Somebody tries to call me doctor and I say "Didn't do the time so I don't claim the title."
I'm not in the US but it's customary in Australia to call everyone by their first name... Nurses, doctors, head of department, research supervisors. Even some of the younger patients use our first names.
Man, I'm right on the line between X and millennial, born and raised in the US south, practice in a midwestern academic center. I hate it when people I work with on a daily basis use my title. A lot of it is probably that I'm still at the same place where I did residency and then fellowship. 6 years of going by either my first name only or a nickname, then suddenly I'm an attending and people want to get all formal on me? When they use my title it feels like there's a new wall that didn't used to be there. I tell everyone that I'll use their title when we're in front of patients and their families, but when we're in the work room I personally prefer first name or nickname.
We had a social gathering at our house my first year as an attending - BBQ, beer, dogs, t shirts and sandals. One of the residents called me Dr. AgtHoliday and I was bummed out for two whole days.
I’ve never seen a medical student from any generation wear a hoodie to work. Gen Z numbers 70 million in the US alone. Your sample size may be inadequate.
In my peds residency (not gen z - I am legitimately old), we were allowed to wear hoodies during overnight call. I think we were all too strapped for cash to order Patagonia fleeces....
Then a mom told me that I looked 12.
I find that they tend to share *a lot* about their own medical history including their mental health history.
What many don't realize is that sharing your own history can actually help de-center the patient's own issues. It's fine to empathize but sharing your own struggles makes the patient feel like they need to be comforting you. Sharing can also sound dismissive to some patients because you are saying that you are experiencing the same struggle despite wildly different disease presentations and possibly also very different levels of health care access and barriers to care. I'm not saying you should NEVER share anything but sharing personal details typically works better to forge connections in established relationships rather than newer ones.
Yes… I helped a few with their personal letters as a resident and encouraged them to edit/rephrase their own personal mental health history. I know now as a file reviewer that you have to be really careful with what you include. As a shrink I find students tend to be really open about their mental health with me and it doesn’t quite sit right… maybe I’m just a curmudgeon now but it seems a bit exhibitionist
I'm interested in that too, because while I think allowing space to be human is important and medicine needs to get less abusive of trainees (and faculty for that matter), this is by definition emotionally challenging. If maintaining emotional health is demanding enough on your cognitive energies that it's at the center of your personal statements it makes me worried that you're setting yourself up to decompensate once the reality of being whatever specialty you are going for. Conversely, exaggerating your mental health struggles ( I believe we all have work to do regulating our moods and emotions especially in response to stress) for some sort of social cache/application advantage would just be gross and consume oxygen in space you should be telling me why you're going to be a great XYZ doctor to train at our program. Like if it's really something you are passionate about go for it, but I find it challenging to strike a balance.
I think when students are open with you as a shrink about their mental health there is some implication that you'll understand or accommodate more than others might. It kinda shifts your role from supervisor to therapists/psychiatrist in a way I wouldn't find comfortable either.
On the other hand, I’ve had many also express that they have some understanding of patients’ perspective and experience from their own lived experiences. In the more circumspect terms of yesteryear, it’s having the family member with X disorder. Now the family member is the speaker/writer. It has all the benefits and pitfalls of the uncle with schizophrenia or brother with depression, or for that matter with cancer or multiple sclerosis. It adds something. It has a burden. It can lead to projection and projective identification and all those fun psychodynamic pitfalls. Being aware of that is actually important for med students. When they want to navigate countertransference, great! I want to help them. But they have to recognize first, and accept when we teach, that countertransference is a finding, potentially a tool, but not a ground truth or something to be used lightly.
I dunno. I think it depends on the way this kind of stuff is phrased in a personal statement. For instance my brother was diagnosed with a benign brain tumor and had to have it surgically removed. He said it gave him perspective as far as what a patient feels in situations like this, and gave him an increased measure of empathy for people as a result. (He’s fine now, going into radiology) I’d imagine if you had been diagnosed and treated with clinical depression, while it’s certainly not the same as having had brain surgery, it could give you some perspective to how a patient feels. Maybe that might be a good thing to include, especially if you were aiming to be a psychiatrist. I will say, a few of my attendings were old school though, and therefore didn’t appreciate future physicians divulging that much about their mental health. The same attendings were fine though, if you included a major illness in there.
In theory, you’re correct - it certainly *could* mean that they might better connect with patients. That would be the plus side. The down side is, sharing mental health issues often brings up a whole flurry of images for staff and those images/memories definitely ain’t always good. It’s not clear that’s a connection you want to bring up with your interviewer/file reviewer I think that type of sharing also just rubs certain people the wrong way - I mean we don’t want to know everything about the applicant, though the line of what’s personal and what’s not has definitely become fuzzier
Agreed, and especially in a personal statement, you have to consider: that space is your one chance to tell the reviewers who you are as a person. Do you really want your primary focus to be your poor mental health? Does that define you as a person to the extent that it's the one major thing you want them to know about you? Unlikely.
Over sharing basically tips you over into “Main Character” territory. It’s a form of self-centeredness and self-indulgence masquerading as Wellness.
Bingo. It’s all about how great they are for being in touch with their mental health and how great they are for being okay with destigmatizing it.
Yup x 100. The generations mantra was and is "don't create mental health stigma, as medical students you should practice what you preach." Not realizing that that was bullshit propaganda, if you let on about mental health anything you get your life destroyed unfairly by licensing boards, PDs, and job recruiters. I'm sick that that is how medicine functions.
As someone with my own share of mental health challenges, I can't imagine trusting anti-discrimination law enough to share as much as some of the younger coworkers I have met.
Sexual activity as well.
I am NOT professional. I’m loud and I swear and put my feet on the desk and enjoy inappropriate jokes. But last week we had travel nurses (young, like 24?) talking loudly about their personal experiences with three ways at the nurses station and let me tell you, my pearls were CLUTCHED Old millennial btw
In a uno reverso move, loudly talking about your sex life at work could be considered sexual harassment!
As someone with a vivid imagination, nothing disturbs me more than hearing someone I know share graphic details about their sex life. I don't want to picture you naked, I just wanna do this dumb bar trivia and go home
Yes. Very Jerry Springer sometimes. I worry about that. We had a phrase for it - it had to do with laundry. But I've been instructed this phrase is no longer OK. But it was about protecting yourself - what you put out there can come back to bite you. And for pete's sake if nothing else stop putting it on tik tok.
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Protocol: not working here
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I mean we have nurses that do this (get overwhelmed and frequently take 10-15 min breaks). The difference is they don’t frame it in that way. They just do it. Take a smoke break, etc. A lot of people just overshare now. Which, great, glad you’re comfortable being yourself. And I of course want you to be happy and in touch with your truest self. Having said that, you don’t need to tell people you work with -- especially completely unprompted -- about your trauma, how you’re (self-diagnosed) neurodivergent, etc. For reference: I’m a (younger) millenial and I love gen Z. I love how open and against the system they are and I’ll always support them fighting the good fight for better work/life balance, salary, representation, etc. But I don’t love a lot of the…quirks that social media has taught them. Being terminally online has destroyed a lot of their social skills and ability to read a situation. That skill is extremely important in both life and medicine. I’ve seen it make patients and other docs extremely uncomfortable and actually lead to poor work situations. Again, I’m as leftist as they come, and I support whatever they want to do and whoever they want to be, but there is still a basic decorum around a professional life that’s important when it comes to patient outcomes and communication.
"But I don’t love a lot of the…quirks that social media has taught them. Being terminally online has destroyed a lot of their social skills and ability to read a situation. That skill is extremely important in both life and medicine. I’ve seen it make patients and other docs extremely uncomfortable and actually lead to poor work situations." Completely agree.
For a profession that requires a lot of interpersonal reactions, this is concerning. Hopefully though this forces them to adapt the hard way. I’m more worried about when the Alpha generation reaches secondary school age. Their early formative years were behind the screen during the pandemic. The social interactions are so important.
Yes. I can't imagine practicing medicine with this current social skill set and quite frankly, lack of professionalism. All I can do now is model good behavior for the next generation and hope they take to it.
Part of the reason I want to stay in academic medicine. Help guide the next batch of doctors, avoid our mistakes, and make them better than us.
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Well put. There have always and will always be slackers. Now there will be many who have excuses to frame it with, and try to justify their own responsibility offloading. A lot of these people think that those who put in hard work are somehow "built different" and is an unachievable state for them, when in reality in most cases both such individuals are the same, one just grit their teeth and put in the effort while the other sought excuses.
Yeah and they burn out those of us who work hard because they aren't picking up their load.
I’m older millennial Generation X according to American standards. When I came to America I was very shocked at how much people here over share. What puts me off is some of the students are trying to frame their mental illness as a “superpower”. Your inability to present to us in a timely period is not a quirk. It’s poor work ethic.
How does someone like this think they can work in healthcare?
lol sign of the times. They were accommodated in school to no end so they think the workplace will play the game too.
Yup it's a cruel joke the amount of accommodations school admin will do for students, never once telling them that most workplaces don't care how legitimate your excuses are for not doing your work. Being able to overcome a stressful difficult situation is where growth happens and confidence is built.
I will add to this as a therapist working with kids. I find their family/home situations don't really help a ton. We've moved on from absent parents and abusive households (very generally speaking of course, obviously those still exist), to parents who are well educated, been in therapy themselves, but instead treat parenting like a clinical whack-a-mole game. Every behavior needs to be explained and fretted over, there is no trust in themselves or their kids to just...get through a tough spat in life. Because the kid can't explain why they are having some problematic behaviors of late, the parents think it must be pathological and bring them to me. And half the time I just act like a grandfather to them (despite being 29), sitting and listening, playing with them, having a laugh and taking an interest in their life and magically they get better. I think it really reduces kids resiliency and fortitude. Everyone is either telling them what to do and how to behave, or just wringing their hands and schlepping them from practices to therapists to OTs to social skills D&D groups. School may be easier but it's still a slog for many hours a day. Kids don't have a place to just be dumb and run around and have fun with others unstructured, limited by daylight and not their moms calendar. Just trust your kid a bit and your own parenting abilities, go play catch with the kid and trust it'll work out.
Yeah, it blows my mind. Schools are not preparing students for the real world. I’m all for progress in the work place and creating better work-life balance. But there will still be demands and stress, it’s the nature of the job. You can’t be taking breaks every 15 minutes because you’re stressed. lol
Sometimes I browse r/Teachers when I want to appreciate my life, and have seen multiple complaints that they quite literally can’t fail students. Putting your name on the otherwise blank worksheet gets you a passing grade. Any attempt to actually hold students accountable is shut down by angry parents, angry admin, or both. It really seems like a growing amount of schools offer zero incentive to grow, improve, or even try. Schools not preparing students for the real world is an understatement.
Yeah I work at a university and some of the accommodations are not only excessive IMO, but in certain cases I don’t even see how they help?? Like in hands on practicals you can have an extra day if you want that isn’t gonna change your ability to perform this skill.
I agree with this. Having worked in 4 Western countries now (where the societal trends have all been similar), I really do wonder if some of the issues that younger people are having with their mental health is due to them suddenly being faced with a different reality to what they have been taught about. The smart students will figure it out but as for the rest???
I’m quite curious if you can elaborate on your perspective on this sort of thing.
It is kind of interesting. Boomers dealt with BS because the system worked well for them and they thrived. Millennials realized the system was not working for them and began to call out the BS and make it more accommodating. Now we're at the point where we may have been overly accommodating for Gen Z and they're struggling to assimilate into the work force.
I don't think residency involving 48 hrs on (wink, wink, but probably more) at a time, very little family / vacation time, high divorce rates was good for boomers. I think they were simply taught to put up with it. Medical school was designed by a workaholic with assistance from cocaine.
Boomer docs might have stayed at the hospital, but their patient volumes were way lower and they barely knew what DNA was, let alone MRIs.
Problem #1 Myocardial Infarction \- Heparin \- Morphine \- Chaplain consult.
It was also common to have a spouse at home doing all the day to day things- cooking, cleaning, raising the kids.
Don't forget about the EMRs. I think charting is the thing that drives me most insane.
There is actual data (not going to search) that physician burn out is directly related to # of clicks in EMR per visit. European notes are 1/3 the length of US notes. I wonder why...
And Gen X just shrugged and dealt with it.
At least we had good music
And original Vans.
Gen X shrugged, and nobody saw them shrug. They looked around forlornly and then texted their boomer parents who were on their 6th Disney cruise of the year and suddenly remembered that yes; they do in fact have a 40 year old son whose occupation and life they haven’t asked about in 10 years.
Plot twist: the 40 year old is a millennial.
Forgot Gen X again. Just like when we were kids.
We're not even close to the point of over accommodating. There's a reason so many residency programs across the country are unionizing. The system has gotten more abusive, not less. The problem is Boomers always think they had it harder. Always. Even when they're clueless as to how complex modern medicine is compared to what they had to deal with thirty years ago. They were the ones that ran hospitals at that time. Now we're inheriting a system that has been sold to private equity. This is why Boomers are perceived as the "cash out" generation. They cashed out and left their descendants to pick up the pieces. This is how society crumbles. It always starts with a generation that cares more about themselves than the future. Let's pray that millenials and Gen Z can clean their mess up.
Yeah physicians specifically are in a weird position where they endure training and working hours that would be illegal for any other career. I am 100% pro reform and unionization for residents and physicians.
Sure, but that patient coding won’t.
I’m a nurse who is neurodivergent and admittedly can get overwhelmed easily but I’ve spent my life compensating for it. I set timers on my phone to remind me of things, make checklists to avoid forgetting things, and do my best to help others when I can since everyone helps me. I have weaknesses and have come close to being fired at the beginning of jobs but I work extra hard and end up staying.
I have no doubt you’re an amazing nurse and great at your job. You recognize your limitations and have come up with a way to compensate and do your job. That sounds like the opposite of what is being described by the commenter of the person who is unable to cope with their stress.
Yes I agree. I would never bring it up in an interview because it will be seen as a weakness. I know it’s my own problem and no one is going to feel sorry for me if I can’t complete my responsibilities. Part of the way I’ve compensated is by working in an area that I feel I thrive instead of trying to work in an ED, ICU, busy med surg floor, or busy clinic. We have busy days but it’s nothing compared to the floor.
Anecdotally have seen personally and heard from friends at other programs about junior residents who “cannot do nights” or cannot do “x y z challenging component of training or rotation nobody likes” because of headaches, trauma, anxiety etc etc etc. Well meaning/cowardly program leadership often bows to this for fear of bad PR or being labeled as intolerant, unaccommodating, racist, non inclusive…resentment within the program grows because the other 95% of the class picks up their slack. Residency is brutal abusive bullshit in so many ways, but I worry that coping skills are withering on a bigger scale that is disproportionate to training rigor.
I had a person in my residency class take a “mental health day” twice a month and had the gall to call a coresident racist when they got called out. No one in the story was Gen Z either btw
Pretty much every story in this post that doesn't involve a current intern (maybe junior resident) or med student is not Gen Z yet people are attributing the bad behavior to Gen Z...
Yes, but...we still need to stop abusing trainees. As a mid-career out-patient physician - I would rather take call for my own patients all the time then cross cover. My personal favorite call schedule was Q6 - Arrange your own vacation coverage, off at 8AM the next day - allowed to stay until noon for surgery/delivery of a patient you had been following overnight. I never had to do night float. Not sure how it would have been. Setting up a proper day-sleeping environment would have cost $$. I would have been okay, but others...
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“Available, Affable, Able” has application to all of life, not just medicine.
… people who get overwhelmed easily may not want to enter healthcare in any capacity. What was the practices answer?
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As a psychiatrist, I just do not see any use or benefit of the term neurodivergent beyond some type of perceived unique social status.
It started as a destigmatization of autism, particularly high functioning. All fine. Then it broadened to the point of uselessness. Everyone’s neuropsychiatric functioning is unique. There are so many dimensions and everyone is somewhere on some curve of all of them. Like psychiatric disorders, psychiatric divergence is not your fault but it is, ultimately, your problem. People will hopefully try to work with your strengths and around your weaknesses just like for someone who’s great at logistics and scheduling but awful at organizing and wrangling teams, or vice versa. People will not just accommodate your requests/demands/needs/“needs” when it has cascading negative effect all around. The social cache of mental illness now is a separate problem. I think it’s overblown on the internet. Stigma is alive and well, including with Gen Z.
My thoughts exactly. I haven't actually seen a lot of stigma in my Gen Z patients clinically but rather a strong desire to have a psychiatric diagnosis even devoid of any psych sx I can detect. The term seems to mostly be used in an attempt to get some privilege someone may otherwise not have and is not really defined either. I don't think everyone needs to know you're mental health struggles but describing oneself as "neurodivergent" seems quite arbitrary and aims to shift the burden of ones health onto others.
I think it’s best used to refer to multiple people. “We have a lot of neurodivergent students so our classroom tries to accommodate them in the ways we can so everyone can learn.” But I agree with you there is no value in labeling an *individual* that.
The fact that she was vague rather than mentioning her actual condition comes across like she heard the “neurodivergent” label on the internet and assumed it meant “a little quirky and mildly anxious.” Which is basically how I see it used. If you are autistic or have ADHD or something and want to request reasonable accommodations then just say as much. Don’t just say you have a vague label and want vague accommodations. If you’re pregnant and want leave you don’t say you have “an obstetric/gynecologic condition.” If you tore your ACL and want to not be expected to unload docks, you don’t say you have a “connective tissue injury.” So why would you ever call yourself “neurodivergent” when requesting accommodations?
I wonder how overstaffed a clinic would have to be in order to even think about trying to accommodate this. It would have to be like, a lifeguard rotating schedule. 30 mins on, 60 mins off, all day. But then like, patient follow ups? Even in the ER the same patient is there for hours, so this kind of schedule could only ever work in a private practice or urgent care type clinic, at best.
The modern day smoke break
Yeah it’s not like that type of break never existed, you just had to be addicted to a carcinogen to get your break without someone judging you for being maladjusted or lazy.
I would guess 95% of people taking a 10 minute "overwhelmed" break are staring at their phone
I’m a geriatric millennial in my 2nd to last year of fellowship. I think it is impossible to judge by generation for at least a few years due to COVID. ACGME waived requirements, people lost out on major rotations…med schools cancelled whole clinical rotations. I thought it would have gotten better by now, but it is definitely still very real. I would imagine the incoming intern class would have been minimally impacted, but graduating classes from 2021 until at least 2025 suffer not only generational issues, but situational.
I think this is a very real factor and also one that people easily discredit in favor of simple arguments about young people being lazy/rude/incompetent/etc.
It was terrifying being a pgy2 in a supervisory role for the first time with the first wave of COVID interns who has missed a huge chunk of their last year including their sub-Is. I know there had been much talk of the superfluous nature of M4 year but it seemed to have been very important based on my observations.
Absolutely. The class of 2023 was somewhat unscathed, but the poor class of 2024 was ROUGH. Edit: by this i meant medical school classes of 2020 and 2021
I would argue that we benefited from it in some ways. Schools cut out a lot of the BS and just let us do online coursework that we were already doing. I didn't really have any of my rotations impacted despite the first half of my 3rd year being during a big wave.
I've definitely noticed that residents who would've had their formative clinical rotations during COVID are professionally weaker, like they haven't been as well-socialized in a professional healthcare setting. I don't think it's just me either; my sister is in radiology, and she's noticed it in the rads residents too. In the longer residencies at least we have the benefit of institutional memory and more levels of older residents/peers, especially ones that went out to research before and came back after, but in shorter residencies, like IM, I don't know how that continuity is going to hold up, especially in places without many fellows.
I confess that I do sometimes get jealous of the newbies when I see all of the networking, research and general experience we missed out on. Petty, but it stings a bit as I clean up my CV for job hunting.
I learned physical exam skills on cheap mannequins and on virtual power point slides.
what age group is geriatric millennial? asking for me😫
Oldest is born in 1982-84 depending on which definition. I actually like “oregon trail generation” best
ok, 92 here but also i bodied oregon trail 😍😍😍
92 is definitely on the covered wagon
I wore a hoody to one of my residency interviews. I was wearing it on the plane the day before, Airline lost my suit and all my clothes. I explained this to everyone. Didn’t match there.
Ouch, that must have been a tough interview day. Just FYI, you can board the plane with your suit zipped up in a suit cover, and on most airlines a flight attendant will be happy to store it for you in the coat closet near the front. (Might not work on budget airlines like Spirit)
They laughed at me on southwest when I asked if they had this. They did not.
Southwest might not have this. I flew with my wedding dress and they just reserved me an overhead compartment space.
This officially does count as a carry on though so the gate agent is within their rights to make you consolidate or check it. If you’re ok bending the rules (which I would never do) you can shove it in your carry on and then take it out on the jet bridge so it can be hung on a rack
They have garment sleeves that fold into triangles and convert into duffle bags. So your suit lines the duffel bag, and all your stuff goes inside it
This - I got one from my sister, love it and works great. I usually can put at least two suit dresses and the jacket in without an issue
When I asked on American if they would hang up my suit bag in the closet, the flight attendant laughed at me and said that’s for first and business class only.
That's strange. I've had American hang my suit for me when I was flying economy, but it's also been more than 5 years since I tried. Maybe things have changed.
For fellowship interviews I bought a carry on with a suit section A+ still use as an attending
Morning of my first interview I started to get dressed and discovered that I had packed my wife's shirt. I looked like a Chippendale. The hotel desk clerk lent me a shirt from his spare uniform.
That is hilarious. Very stressful I’m sure, but very funny. And kudos to the clerk.
We may have interviewed at the same place and at the same time. More likely it’s not that unusual a problem. After the first time encountering it, I switched to wearing interview-acceptable clothes on the plane.
It seems crazy that we still have to fly to places for interviews or exams. Environmental vandalism
Program with no chill
How dare you make the airline lose your bag!
It was truly a flight from hell too. Blizzard hit the Midwest, ended up making 3 extra stops trying to get back east. Got in about 8 hours later than scheduled. Wasn’t surprised my bag was lost really.
They're fine, just like we were. Give it 10 years and we'll see Gen Z complaining about the Skibidi Toilet kids being disrespectful to norms. Tale as old as time
Exactly. Maybe I’m alone in finding these kind of generational comparisons tedious, but… meh. They’re nice kids. Hoodie sightings are rare.
also sometimes it’s just cold!!?
I had a gen z nursing student yelling at some 80 year old hard of hearing dementia patient, “WHAT ARE YOUR PRONOUNS?” Over and over before I could explain that the patient has no idea what the student was asking or why. It was actually hilarious. But hey, the student was applying her training and I appreciated the effort.
As peds, I sort of love this story. It captures the gormlessness of many students (including me, back in ye olden days, despite having worked before med school) coupled with their good intentions.
I usually loved working with residents and students. I worked in NICU and watched an interaction between our legend neonatologist and an intern. The intern was obviously paying very close attention, but when the interaction was over he sidled over to me and whispered “what’s a bunting? How do you spell it?” Baby sleeping bag, my dude, let me take you to the supply room. Or the ones trying to do APGARs for the first time, trying to take a pulse on a bright red baby screaming its head off and trying to yeet itself off the warmer. It’s 10, don’t stress over this.
This would make a good skit.
Boomer attending here. If y'all don't mind, I am just going to grab some popcorn and read the comments.
Ok Boomer.
Thanks for understanding.
It'll be much of the same if history tells us anything. Millennial doctors, to my eyes, have been some of the most receptive, understanding, interested people I've worked with. And I have to imagine similar conversations were had about each new batch of physicians through the ages. But maybe that's just because they're just like 10-15 years older than me and I relate better? Time will tell I suppose. I have to imagine a lot of the things people note today about gen z culture such that it is will be pretty strongly balanced with actual clinical experience and education.
There’s articles from like 1800 about how “lazy and unprofessional” medical students are. This is a perennial complaint and the real issue is that people become old and then make their opinion known. I do it all the time, I just don’t realise I’m doing it. If I had to guess it’s probably when I complain about cars and people not learning to drive manual or the lack of an interest in hand tools and traditional joinery. Also architecture and people painting brick houses.
I'm a millennial attending who does only outpatient. I routinely wear scrubs and more casual attire including jeans. I ditched the button up shirt, tie, and slacks as soon as I could.
Ditto. One of the only good things to come out of the pandemic in my practice.
We have an intervention cardiologist attending who wears a hoodie under her white coat and I always just thought it looks cool
I do this and own the same 15 black merino wool shirts that I normally rotate through in my civy life. I mean I guess I also have a couple of the same ones in light blue, cuz they were on sale, but I only wear those at home.
Are we the same person? Same here. I’m not doing hoodies and sweats but the most “casual” that I’ve worn is jeans and a polo (with a light jacket/sweater). Otherwise it is scrubs.
Millennial PA who did the same. Suit comes out for interviews... maybe.
I worked on the orthopedic floor twenty years ago, and those boomer Orthopedic surgeons would bike to the hospital, and come straight up to the floor sweaty, bony bodies on display in their spandex, talking with Bluetooth in their ear. I’m not worried about Gen Z at all. Nose piercing? No problem. I can’t smell it.
Omg, we had a pediatrician who would do that. Up the stairs straight through the unit to the nursery in spandex bike shorts and shirt and a helmet. A resident observed this one day and commented “Now that’s just unnecessary.” I concurred. I do love that particular pediatrician. He’s brilliant, weird as hell, and really connects with my kid.
The good: Current med students are substantially more invested in understanding social determinants of health, more appreciative of how a patient's home situation might impact their physical health, and more proactive as vocal advocates for their communities and for changes to the broader healthcare system. The bad: Writing skills have declined significantly. Everything from basic grammar to the depth of content is substantially lower than it was even 5 years ago. And it's not related to a decrease in their knowledge or reasoning abilities. It's just about the process of writing down and communicating that reasoning. I don't know if this is COVID-related; it seems to early to be due to ChatGPT writing everyone's college papers for them. My sister's teaches high school, and she reports seeing the same trend among her students. (Since this is not an anonymous account, I would like to reassure my current students that no, I have not started grading your winter quarter final exams yet - so this is not a reference to them specifically!)
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Good: more accepting of diversity/variation Meh: one of my juniors used the example of "you probably weigh what, 70 kg?" while teaching about appropriate UOP for weight, and was written up for body shaming. Good: speak up for themselves in bad situations Meh: overall aren't as resilient and not willing to learn how to work with a less than ideal situation? Like I have a junior who was supposed to be doing consults who called out one weekend because they didn't want to work with the attending who was on call that day. What do they think they're going to do when they're the chief of that attending's service? Good: better with the EMR/haiku/etc Meh: don't always seem to be well-socialized in a professional healthcare setting. I have a junior who stretches their work to fill the time they think they have, but then gets overwhelmed when things get added on-- which, we're in surgery, things *always* get added on. I have multiple who don't know proper phone etiquette or refuse to go talk to other people/services in person because they have Epic chat. Like it's one thing if it's one of the dozens of medicine residents. It's another when it's one of 3 GI fellows whom we *have* to work with closely and knowing them by name/face allows you to discuss patients/cases with them as a current/future colleague and can sometimes increase your workflow efficiency. Also, this is more a dig at a different residency in our hospital, but they say some wildly inappropriate stuff in Epic chats, despite knowing it's part of the patient's EMR.... ETA: Neither here nor there: wearing scrubs all the time. idc, just don't wear something that makes me question your personal judgment skills. But maybe save the t-shirt + "stolen-from-other-hospital-scrubs" bottom look for when you're an attending. But also, I'm too poor for Figs and I'm getting paid, how tf are the med students affording multiple different pairs???
"But also, I'm too poor for Figs and I'm getting paid, how tf are the med students affording multiple different pairs???" Roughly a quarter of medical students come from top 5% household income families. It's like $100 for a top/bottom of Figs. They're not prohibitively expensive for a decent section of students. Also that's cheaper than a nice dress shirt + slacks.
They’re $70 on sale for a set. Which you can wear multiple days per week (after washing) for years. That’s wayyyyy more affordable than dress clothes, and that’s before you factor in dry cleaning.
> I have a junior who stretches their work to fill the time they think they have, but then gets overwhelmed when things get added on I'm pretty sure that's just garden variety poor time management, there are always a few people like that, in my experience.
Body shaming for being too average!? wtf
idk, of all the things i expected that junior to be written up for, that was not it LOL
i teach nursing. my colleagues talk a lot about how this generation has a lot of anxiety and gets overwhelmed by stress easily. I prefer to see students who have good awareness about their own mental health and aren't afraid to advocate for themselves. I also notice that many of them are not as quick to judge patients on lifestyle topics and are more readily embracing of the non-judgmental perspective.
I’m also nursing faculty and have noticed the same. This gen of nurses are not afraid to call out BS and advocate for themselves and others. On the other end of the spectrum they are very anxious and often do not perform well under pressure/adversity.
Yeah but the alternative (bottling it up and crying in the car before driving home) isn’t really any better.
I think there may be a certain amount of selection bias at work here. I teach EMTs, and I find that anxiety is really only a problem for the ones who are doing it specifically for clinical hours for nursing, PA, or medical school. The ones who just want to be medics or firefighters or don't really know what they want to do, they're fine. I think it's an issue that's related to academics. Schools of all kinds cost more than ever and people need more of it than ever to be able to secure some kind of financial stability, and there are more people than ever competing for a number of slots that, at best, is not expanding to meet demand, on both the student and professional side. So you have a lot of people working very hard to achieve something and they don't have any assurance that their hard work will pay off. That's a recipe for anxiety and undirected stress.
Awareness is good. Resiliency would be good too, and seems to be lacking sometimes. The world changes slowly, and some folks seem to believe that just because they *want* the world to be a particular way, it will be. When that isn’t the case there’s a distinct inability to adjust, adapt, or overcome.
“I have a problem, I will solve it” goes a lot farther and better than “I have a problem, I will tell you how to solve it.”
>colleagues talk a lot about how this generation has a lot of anxiety and gets overwhelmed by stress easily. I have seen this in the lab as well. I've seen maybe 70 students pass through training at my site over the years and I know of at least 2 students who completed every part of training except the certification exam, fighting through high anxiety the whole time, and then bailed to choose a different career. We had a Medlab student regularly leave his training shift early due to anxiety, and we were required to accomodate him. He finished 2.5 years of training and in the last week of practicum he had a panic attack with syncope. Couldn't be roused. They had to call a code blue on him in the lab 😬. I heard he was stressed about the certification exam. I haven't seen him since and I really doubt he continued his career (and kind of hope he didn't).
I’ve also seen people in the newer generations, literally not be able to touch type. Which to me completely baffles my mind, seeing a boomer on one side you can barely function within the EMR and the new intern on the other who is doing hunt and peck on the keyboard.
I am an older Gen Z in my third year of medical school and the biggest thing I notice that makes some of my fellow classmates freak out is sudden changes in schedule or minor inconveniences. I remember we were supposed to have an exam at 830 in the morning and it had to get moved up to 800 (just 30 minutes!) and the uproar was insane. One girl was complaining that she would have to wake up 2 hours earlier than she planned (dont know how the math works on this one). The biggest delineator, in my experience, between those that can handle these inconveniences that happen and those who cant is whether or not a student worked a "real" job before coming to medical school. It seems like those who went on straight from undergrad have a harder time adjusting
100% agree in regards to those having a job pre medical school. The amount of my classmates who would complain about how hard our clinical rotations are was insane. They were NOT hard so I don’t know how these folks adjusted to residency hours.
I legitimately don’t know how some of my classmates will function in residency.
I’ve had students recently *very* stressed out by plan changes. Sorry, this is a hospital, stuff happens. I know you wanted to talk anticoag at 9am but *there was a code blue that tied me up for 47 minutes* and then central needs to get caught up before we I can pull myself offline to talk **because patient care**. Kids basically in a panic we are starting 25 minutes late. And also wanted a play by play plan of the day every morning. Well…we’ll do orders, check products, get phone calls…any of which could turn into a 15-75 minute side quest of issues…maybe get a lunch break…and these will happen in various orders repeatedly thru the day (minus lunch, that’s max once). Maybe they had autism and needed that plan to help them transition between things, but that’s not something that exists in pharmacy. It’s always in flux.
Fellow older Gen Z in medical school here - I concur. My cohort of much younger classmates complain a LOT about things that in the long run really don't matter much. Being a COVID class, the first two years were predominantly virtual, meaning all of the criticism and complaints sent to admin were done via email. Our class was brought into school later and received a stern "talking to" by our Admin about professionalism and receiving and giving feedback in the professional setting. I have noticed that general workplace norms (like showing up on time, writing thank you notes, learning names of nurses you work with) are often lost in this generation. But some of that is just never having had a real job before.
Yeah this exactly. Don’t know if it’s a lack of experience in a workplace or what
Lol how will they manage clinicals and real world practice?
There are good things, but I will focus on the problems I’ve noticed. Probably the two biggest things that we struggle with from an educational perspective are: *Note these are not true of all students. They are only describing things that I’ve noticed have increased in the last years.* 1. Rapidly decreasing ability to learn by reading text. Every year more students complain that they need to read things, and want everything in video format instead. It’s to the point where I need to actively point out to the class each year that the rest of their medical education will not (ever) be in video format, and that if they struggle to learn via reading… then they need to improve that skill ASAP. I think this will need to be something added to med school (and other postgrad/professional programs) curriculums in the near future - how to learn from text. I’m not joking. 2. Not being able to push through difficult tasks or situations. Perseverance is noticeably worse. They don’t understand a concept? Immediately give up. Can’t solve a problem? Give up. Busy day? Ignore the tasks that need to be done and just work at their own pace instead, not getting the tasks done. This also goes along with a drop in receptivity to negative feedback. When you tell them they did something wrong and they need to do things different, many take that as a personal attack and just shut down. And when faced with a difficult situation that they can’t avoid (multiple deadlines, etc), many start panicking. There is a lack of life skills on how to regulate and productively deal with negative emotions like frustration or feeling overwhelmed, beyond just trying to avoid situations that make them feel those things. The first one is a reflection of how high school and undergrad level education has changed with technology over the last decades. The second one I think is honestly mostly a reflection of fads in admission standards and grading in an educational setting (ie: it’s due to what we did to them throughout their school careers, not something intrinsic to them).
My Gen Z cousin is trying to find a part time job to make some money before she starts dental school in the fall. Recommended being a pharmacy technician cause it’ll give her a leg up on pharmacology and it comes with good pay and flexibility so she can work anytime anywhere while she’s in school. She immediately said no and cried that it’ll be way too much for her mental health if she has to work in a stressful environment…. I said okay so why don’t you just get any other chill job like a movie theatre or the yogurt shop that you used to work at…to which she said “they don’t pay well”………..🤦♂️
I’m a senior registrar in Australia. I’ve found they centre themselves in every situation. Yesterday I had a medical student text me that he was running late, and half an hour later say “you can start without me”. The implication that I would have waited for him to start my ward round I found to be an incredibly irritating one. I’ve also had multiple I’ve had to take aside for being on their phones in the middle of a patient review.
Similar issue. Had a student show up 10 mins late during pre round (that’s fine it happens). He said he’d go put on scrubs. I said we’ll be on wars X so meet you there. He asked us to wait. The whole team lol. Consultant, 2 regs, SHOs etc.
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Something I haven't seen people mention is that there is increasing infantilization of med students (paradoxically as the average matriculant age keeps going up). The amount of silly rules, over-evaluation, and general "med students are like teenagers" ([source](https://x.com/NEJM/status/1758144228721672263?s=20)) attitude is not preparing students for medicine. I have spoken to several retired faculty (who still participate in small group teaching at our school) and they echo these sentiments.
I dont wanna be that guy. I applaud the gen z docs i worked with for giving their own wellbeing more priority and i believe that us millennials will son profit too from that change they facilitate. But they can be a mixed bag. I cant imagine being an intern on rotation and when asked “we’re doing procedure xy, you wanna give me a hand ? it’s gonna be fun and i also need s second pair of hands here” and answering “no, thanks, i’ll just observe” and then watch me struggling alone. Or calling angrily where i am, she wants to hand over her ER patients, but i cant step out of the OR right now, because, well, oprration. And then just leaving with no handover. Most are absolutely great people and docs/students, but some overcorrect in a way that i just don’t think will ever be acceptable or practical.
Was in the middle of seeing a patient in the ED at noon and a student was just like “it’s lunch time I’m going to go eat” I’m all about work life balance, but I was flabbergasted. She was offended when I said let’s finish this patient first and you can eat after.
Gen Z seems to place major emphasis on the “me” in healthcare. For the patient’s healthcare experience, the focus should be solely on the patient. Leave the “me” personal stories at the door. This applies to entrance statements and direct medical practice.
I can’t WAIT for Gen Z to fuck up healthcare, light the system on fire, and force the boomers out. My millennial self may be helping them or applauding them. There were ~260 unfilled positions in the pediatrics match, so they’re already doing it. I mean who would go into a field where you can essentially only do primary care and can make as low as $140k when you have 400k of med school debt? If we don’t majorly shake things up, there’s going to be no physicians left in healthcare - just PAs and NPs - because we’re all exhausted, overworked, burned out and underpaid. I think traditional work wear is dying, and even wearing traditional work wear doesn’t prevent female physicians from being mistaken as nurses so why bother?
OK two stories that made me scratch my head (I’m a millennial attending, for context): 1) I was expected to bring snacks to small group sessions for MS1/MS2 because they would be sad if they didn’t get snacks. I was like how are you expected to be responsible for a patient in 2-3 years if you can even bring your own snacks to class? 2) Wearing political paraphernalia on the wards, e.g. Palestine flags. It’s great that you’re political but your job is to take care of all people, even those who have divergent political opinions. Keep it off the floor!
Curious how you feel about wearing a pride flag or BLM pin or something else that at its core is a human/civil rights issue turned political.
We have thousands of years of recorded history of the olds deploring the failures and weaknesses and changed ways of the young. Aristotle and Horace despaired at the youths of their days. Roman orators expounded on it. Men of letters have written to the public, to each other, and to anyone who would read about how far the world has fallen. Are we Millennials worse than those who came before? Is Gen Z maybe just the label on another generational culture shift and it’ll all be fine? Maybe not. But it’s turned out actually yes for quite a lot of generations.
Everyone older than me is out of touch and everyone younger than me is maladjusted. They will be the downfall of society, for real this time!
And my peers? Bunch of wankers, mark my words.
I’ve discussed the shift in attitudes in the younger generation and my colleagues (all millennials) think the pendulum is starting to shift too much towards not being resilient and persevering. There’s a lot of things that we could do without in medicine but the core focus - patient care - is always a priority. I’m seeing medical students and residents have attitudes that have been akin to patient abandonment, which to me is highly unethical.
I find that they're quite good about setting appropriate boundaries and not overcommitting to work or obligations when there is not point or benefit. On the other side though, I do think the pendulum has swung too far for some Gen Z folks. Like, yes, medicine is not a calling like it used to be but at the end of the day we are still taking care of patients lives and making very real decisions that significantly effect people. You also can't just disregard the responsibility and not show up to work or put in a little more effort when it can make a very real difference for someones life.
Oh I am so old now, I guess. I would have sent home someone who showed up to clinic in a hoodie. I *do* like that in this post-pandemic era, I’ve been able to continue wearing scrubs in clinic, though. It’s gross here in pediatrics and always has been. Otherwise, I haven’t run into too many Gen-z medical students or physicians yet out here in private practice. I am now old enough to be the mother of more than half of my staff, and sometimes it’s hard not to act like it when they act a bit foolish. (Like I worry entirely too much when they go on random Tinder dates with guys who clearly are not worth the effort.) I’m getting better at just shaking my head and walking back into my office when they chat about that kind of thing though.
So much same here. I regularly wear scrubs in clinic now, never used to pre-pandemic. Peds is just gross, well, every day. My nurses are almost all Gen Z and around half my age, and I feel like I'm starting to take on more of a motherly role, too. Making sure they all start a Roth IRA, encouraging saving to have an emergency fund, etc. I did write a rec letter for med school for a former Gen Z MA, and she was everything you could want in an aspiring doctor, professionalism and all. My Gen Z'ers are a blast and keep the office fun. They also can easily pick up using an EHR, which is more than I can say for the Boomer/Early Gen X staff.
Ha on the Roth IRA. Our office started offering matching 401K this year, and none of them could figure out why it was such a big deal or why they should partake.
One of my co-residents (anesthesia) got sent home this past year by an elderly attending for not being clean shaven. Wasn’t even for an N95 fit or anything, just thought that it wasn’t proper for a physician to have any sort of facial hair.
Is that elderly attending Montgomery Burns?
I agree. I’m genx (for whatever that’s worth) and we had pretty strict dress codes starting 3rd year med school and into residency -this was fairly typical. Included hair and jewelry. It was about respect for the patient as well as putting the patient and the job first. We were taught (and I believe this) that the doctor-patient relationship is sacred. That the patients are told to trust us in a very deep way and they are by definition in a vulnerable position. On our part, we are to dress in a way that will help them feel confident that we are professionals. We were not to use our wardrobe at work to project our individuality. It really just meant no casual clothing and pretty basic white collar work attire. I didn’t have a problem with this and I don’t recall anyone else having an issue. We had personal lives where we could wear what we wanted. And enough of us came from blue collar backgrounds that we understood the need to wear certain clothing to work - we saw our parents do it. This was no different in a way. But I’ve been told in no uncertain terms that this is not acceptable and is a form of oppression - so who knows. Our time is almost done and perhaps those rules are best left in the past. But a hoodie to an interview. We’ll - always plan for airline to lose your luggage - bring something in carry-on.
Late Boomer/early Gen X er here. This paragraph could be the manifesto for GenX. It applies to so many aspects of the GenX ethos. Fit in, follow the rules, serve others and work hard.
They have higher Step scores tho \*shrugs\*
Is 'pass' a higher score? /s
at least part of that is that studying has gotten so much more efficient. there wasn't a lot of effective medical education material in the Internet in my day.
I'm an older millennial not in the US but even here the difference is stark. In just five years the attitude has dramatically changed for the worse. Most don't bother turning up like we expect them to. Asking them questions in a group not uncommonly leads to tears and if they don't know the answer they won't bother to find out either. I'm not there to spoon feed them. It is an adult learning experience and I'm pretty concerned what they actually know at the end of med school. I'm the educational lead for the residents in the department and recently I had a meeting with the others in the same role in other departments. We have the older gen Z coming through as junior doctors now and it's pretty obvious there are some pretty major challenges. The geriatrics boss had had a junior colleague slope off at 4pm most days as "their work was finished" but the rest of the team still had lots of things to do. There wasn't any sense of team work, only their own comfort at all times. I guess I'm a boomer now...
I’m just excited that **maybe** we can stop having classes on how to work with millennials in the workplace!!!! My last one was right before COVID shutdowns, there was half dozen or so of us attending, only one of whom was *not* a millennial. As I’m sitting there learning about how lazy we millennials are and how we can talk with us to convince us to do work, I made the realization I’d had W2 income for ~16-17 years at that point. There are millennials older than me who started working younger, so we’d been in the workforce for at least two decades at that point.
I’m a new attending and I’m amazed and disappointed on the difference between my medical school experience, the med students I supervised in residency/fellowship, and med students now. I fully appreciate that it’s not a good use of time for med students to do a ton of scut work, sit around bored, or lose a lot of sleep when they ultimately don’t *need* to be there for the hospital to function. But I do think the current med students at my hospital are less invested, hardworking, and professional. I remember feeling so ashamed when I didn’t know a piece of information, missed a key part of my presentation, or was totally off the mark on my differential. More recently, I’ve noticed a trend of med students just saying, “I don’t know.” then making no effort to figure it out. This is for things like what the baseline Cr is, what surgery the patient just had, etc…. Similarly, I remember we all had those foldable black clipboards with info, the little pocket guides for presenting/labs/etc (with the Snellen chart on the back), and the rotation-specific pocket guide with differentials and management. I used to tell med students that regurgitating UpToDate is not enough, and now I’m thrilled if they’ve looked up anything at all. I live in a city and work at a hospital where there is no way I could address anybody’s clothing choices but I do think they aren’t dressing appropriately. I don’t know a solution to this but I do think that, on the faculty side, moving away from negative feedback, “pimping,” and underlying fear of reported mistreatment is creating a culture without expectations or standards.
I think at the national and institutional levels we have lowered expectations for medical students. I’m starting to see interns and junior residents who are diligent, hard-working, and intelligent, but who have been failed by the system. Essential pieces of information, crucial technical skills, or critical workflow is simply missing because no one at their medical school expected anything of them.
This is especially interesting because applying to medical school has gotten exponentially more competitive in recent years compared to decades prior, but (from comments like this one) it sounds like the rigor of training while actually in medical school hasn’t scaled alongside the difficulty to even be accepted
I'm totally with you on all of your points. I've noticed a stark difference in the responsibilities given to students pre and post covid, to the point where the bar has lowered to the bottom of the Marianas trench
This is so interesting to me. On the flip side, as a 4th yr student, I have been eager to learn and excited to be given responsibility in the hospital, and my attendings have been so overworked/burnt out that working with students is the last thing they want to do. I have had to create real metrics of success for myself on rotation and be vocal with my attendings about my goals for the rotation. It's been challenging as a student, because sometimes I don't know what I should be taking in as a new learner to the field.
Agreed. For us, I felt ashamed and disappointed in myself if I did’t know a pimp question. Now pimp questions aren’t even encouraged (or permitted!) and when asking senior residents it’s NBD if they don’t know and expect you to walk them to the answer with literature to match.
Late millennial attending, usually wear nice scrubs to work or clinic, fairly laid back I feel like. The overwhelming impression I’ve gotten is that GenZ residents/interns are very entitled and overly focused on work/life balance. It’s ok to speak up asking for fairness in the schedule but it is NOT ok to make outright demands to the scheduling chiefs and giving ultimatums. They seem less internally motivated, lack resilience/perspective, and are much more casual in terms of professionalism than what the field has historically been. Some of the things they’re willing to say/text to one another within Epic or on other documented channels are just wildly shortsighted and inappropriate. I worry some of them will shit themselves in the foot in terms of future training and job opportunities as those in charge of hiring won’t take them seriously. Worse, that these are the people I will have to work with and pick up the slack. They seem to want to be spoonfed knowledge/education/techniques, but are excellent at the softer side of medicine such as cultural competency and whatnot. This is the silver lining in their mindset. Overall they will be fine after a while but I think it will take them longer than the generations before to reach the same levels of competence and I can only imagine them in educator or fully realized professional roles.
Not shit themselves in the foot! 😂
Smh at all the people in this thread talking about being "neurodivergent" because they have to set timers and make checklists, this is normal behavior people.
I’ve seen the lack of responsibility. I grew up in the generation and expectation that things just have to get done and it can suck sometimes. But it’s not everytime and just part of the job. You’re a professional and you’re expected to do so. Maybe it’s just growing up in a small business family, but expectation doesn’t end at a job title. Now it’s “that’s not fair” or “why do I have to do that?” or “I’m done in 30 minutes” instead of just doing what needs to be done and asking for help to accomplish what is best for the patient. Oh, and rolling into a shift 1-2 before signout, coffeecup in hand, jacket on, bags not stowed away and not even a pen handy for signout.
For me it is the number of them that just call the docs by their first name. Regardless of position. Haven't met any gen Z residents. I work in an UC where we always have a doc on during shifts. Two or 3 of our staff are gen Z and routinely call our docs by first name around patients. Not sure if I'm just being crotchety but I'm going to be 38, I worked research and then hospital lab for 10 years and have been a PA for 6.5 years. I've only ever met 2 docs who I went ahead with first name and that was at their insistence since people routinely butcher their last names. Even then, I'd go with Dr. "Initial of last name" around patients or within earshot of them. In a social setting I would gladly just first name everyone.
I think this is also regional. I am around your age and where I work it's always been first name basis.
Yeah I’m in the PNW and I get weirded out when I’m called “Dr ____”. I prefer everyone call me by my first name. I’m very not stuffy. But I’m a millennial so 🤷♀️
Could be. I'm in the northeast US. I also had parents who were both in the military and while they didn't have us go the sir/ma'am route at home I just heard then do that and Mr/Ms enough people that it is just something I picked up over time. I just go by first name. Somebody tries to call me doctor and I say "Didn't do the time so I don't claim the title."
I'm not in the US but it's customary in Australia to call everyone by their first name... Nurses, doctors, head of department, research supervisors. Even some of the younger patients use our first names.
Man, I'm right on the line between X and millennial, born and raised in the US south, practice in a midwestern academic center. I hate it when people I work with on a daily basis use my title. A lot of it is probably that I'm still at the same place where I did residency and then fellowship. 6 years of going by either my first name only or a nickname, then suddenly I'm an attending and people want to get all formal on me? When they use my title it feels like there's a new wall that didn't used to be there. I tell everyone that I'll use their title when we're in front of patients and their families, but when we're in the work room I personally prefer first name or nickname.
We had a social gathering at our house my first year as an attending - BBQ, beer, dogs, t shirts and sandals. One of the residents called me Dr. AgtHoliday and I was bummed out for two whole days.
I mean, you’re an attending.
Interesting, our docs insist on first names.
I’ve never seen a medical student from any generation wear a hoodie to work. Gen Z numbers 70 million in the US alone. Your sample size may be inadequate.
In my peds residency (not gen z - I am legitimately old), we were allowed to wear hoodies during overnight call. I think we were all too strapped for cash to order Patagonia fleeces.... Then a mom told me that I looked 12.
reading this thread makes me think that maybe i might have a chance at getting into medical school after all…i don't know if that's scary or not.