Radioactive Seed Localization of Nonpalpable Breast Lesions: Better Than Wire Localization

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Management of Age Diversity Implications for
Medical Education and Practice
Richard J. Gray, MD Surgery Residency Program
Director Associate Professor of Surgery Mayo
Clinic Arizona
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Management of Age DiversityIntroduction

• When you were in high school, what would you have
  thought of

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Management of Age DiversityThis years new
residents

• Were 10 when the Soviet Union broke apart, and do
  not remember the Cold War.
• Have never feared a nuclear war.
• Their lifetime has always included AIDS.
• They are too young to really remember the Space
  Shuttle Challenger blowing up.
• The CD was introduced the year they were born.
• "The Tonight Show" has always been with Jay Leno.
• McDonald's never came in Styrofoam containers.

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Management of Age DiversityIntroduction

• The workplace you and we inhabit today is awash
  with the conflicting voices and views of the most
  age- and value-diverse workforce this country has
  known
• Zemke, Raines, and Filipczak in Generations at
  Work

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Management of Age DiversityGeneration Y

• "Gen Y has created a need for a cultural overhaul
  that has not been this dramatic since women
  entered the workforce en masse."
• Jenny Floren of Experience, Inc.

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Management of Age DiversityIntroduction

• A hiring bonus? Wet behind the ears and he wants
  a hiring bonus? At his age I was just happy to
  have a job!
• They have no work ethic. Theyre just a bunch of
  slackers.
• I will not attend meetings after 5 p.m. I have a
  life.
• If youre looking for loyalty, buy a dog!
• Zemke, Raines, and Filipczak in Generations at
  Work

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Management of Age DiversityAge Groups
Boomers (1946-64)
Generation X (1965-79)
Generation Y (1980-95)
1940
1950
1960
1970
1980
1990
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Management of Age Diversity Disclaimers

• Generalizations helpful for discussion
• Generalizations limited when applied to
  individuals or segments (i.e. residents)
• Dividing lines between age groups hazy
• Early members on one group much like late members
  of the previous

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Management of Age Diversity General Perceptions

• Baby Boomers think Generation X and especially
  Generation Y are uncommitted slackers
• Generation Y thinks Generation X is a bunch of
  whiners
• Generation X thinks Generation Y is arrogant and
  entitled
• Both Gen X and Y think Baby Boomers are
  money-hungry workaholics

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Management of Age DiversityGeneration Y

• More than 70 of older employees are dismissive
  of younger workers' abilities.
• Nearly 50 of employers say that younger
  employees are dismissive of the abilities of
  their older co-workers.
• Survey by Lee Hecht Harrison

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Management of Age DiversityIts not age its
culture
Boomers (1946-64)
Generation X (1965-79)
Generation Y (1980-95)
1940
1950
1960
1970
1980
1990
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Management of Age DiversityAge Groups
Baby Boomers (1946-64)
Generation X (1965-79)
Generation Y (1980-95)
1940
1950
1960
1970
1980
1990
Raised by parents who made sacrifices during WWII
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Management of Age DiversityAge Groups
Boomers (1946-64)
Generation X (1965-79)
Generation Y (1980-95)
1940
1950
1960
1970
1980
1990
Postmodern Worldview becomes pervasive
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Management of Age DiversityAge Groups
Boomers (1946-64)
Generation X (1965-79)
Generation Y (1980-95)
1940
1950
1960
1970
1980
1990
Self Esteem Movement and Helicopter parents
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Management of Age DiversityGeneration Y fallout
from Self Esteem movement

• But enough about meWhat do you think of me?

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Management of Age DiversityGeneration Y fallout
from Self Esteem movement

• 1982-2006 study of college and graduate students
  on Narcissistic Personality Inventory
• 67 of late Gen X and Gen Y qualify as
  narcissistic
• 30 increase over 24 years
• More confident and assertive
• More entitled and frustrated
• Authors asserted direct result of self-esteem
  movement

Jean Twenge in Generation Me Why Todays Young
Americans Are More Confident, Assertive, Entitled
and More Miserable Than Ever Before
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Management of Age DiversityMedical Education

• Compare attitudes and approaches to training,
  work, and profession

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Management of Age DiversityApproach to Work
From Marilyn Moats Kennedy Career Strategies
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Management of Age DiversityApproach to Work
From Marilyn Moats Kennedy Career Strategies
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Management of Age DiversityApproach to Work
From Marilyn Moats Kennedy Career Strategies
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Management of Age DiversityLifestyle
Characteristics
From Marilyn Moats Kennedy Career Strategies
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Management of Age DiversityMotivations
From Marilyn Moats Kennedy Career Strategies
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Management of Age DiversityCommunication Styles
From Marilyn Moats Kennedy Career Strategies
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(No Transcript)
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Management of Age Diversity Medical Education

• A hiring bonus? Wet behind the ears and he wants
  a hiring bonus? At his age I was just happy to
  have a job!
• They have no work ethic. Theyre just a bunch of
  slackers.
• I will not attend meetings after 5 p.m. I have a
  life.
• If youre looking for loyalty, buy a dog!
• Zemke, Raines, and Filipczak in Generations at
  Work

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Management of Age DiversitySurgical Education

• A hiring bonus? Wet behind the ears and he wants
  a hiring bonus? At his age I was just happy to
  have a job!
• They have no work ethic. Theyre just a bunch of
  slackers.
• I will not attend meetings after 5 p.m. I have a
  life.
• If youre looking for loyalty, buy a dog!

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Management of Age DiversitySurgical Education

• Pass off more cases to the intern? Who does he
  think he is? When I was an intern, I was happy to
  just sniff the OR!
  
  
• They have no work ethic. Theyre just a bunch of
  slackers.
• I will not attend meetings after 5 p.m. I have a
  life.
• If youre looking for loyalty, buy a dog!

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Management of Age DiversitySurgical Education

• Pass off more cases to the interns? When I was
  an intern, I was happy to just sniff the OR!
• They have no work ethic. Theyre just a bunch of
  slackers.
• I will not attend meetings after 5 p.m. I have a
  life.
• If youre looking for loyalty, buy a dog!

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Management of Age DiversitySurgical Education

• Pass off more cases to the interns? When I was
  an intern, I was happy to just sniff the OR!
• They have no work ethic. Theyre just a bunch of
  slackers.
• I will not attend meetings after 5 p.m. I have a
  life.
• If youre looking for loyalty, buy a dog!

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Management of Age DiversitySurgical Education

• Pass off more cases to the interns? When I was
  an intern, I was happy to just sniff the OR!
• They have no work ethic. Theyre just a bunch of
  slackers.
• I will not attend meetings after 5 p.m. I have a
  life.
• If youre looking for loyalty, buy a dog!

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Management of Age DiversitySurgical Education

• Pass off more cases to the interns? When I was
  an intern, I was happy to just sniff the OR!
• They have no work ethic. Theyre just a bunch of
  slackers.
• Do I have to count that day as a vacation day
  since I rounded on my patients that morning?
• If youre looking for loyalty, buy a dog!

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Management of Age DiversitySurgical Education

• Pass off more cases to the interns? When I was
  an intern, I was happy to just sniff the OR!
• They have no work ethic. Theyre just a bunch of
  slackers.
• I will not attend meetings after 5 p.m. I have a
  life.
• If youre looking for loyalty, buy a dog!

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Management of Age DiversitySurgical Education

• Pass off more cases to the interns? When I was
  an intern, I was happy to just sniff the OR!
• They have no work ethic. Theyre just a bunch of
  slackers.
• I will not attend meetings after 5 p.m. I have a
  life.
• My job is to become an excellent physician, not
  promote the Mayo Clinic.

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Management of Age Diversity Perceptions

• 68 of Baby Boomers think the younger
  generation does not have as strong of a work
  ethic and that makes their job harder.
• 32 of Generation X think the younger
  generation does not have as strong of a work
  ethic and that makes their job harder.
• Generation Y thinks they have a good work ethic
  that they are not give credit for.
• Into this atmosphere comesduty hour restrictions

Linda Gravett and Robin Throckmorton. Bridging
the Generation Gap
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Management of Age Diversity Faculty Perceptions
of Work Hours
Worse
Worse
Worse
Better
Reed et al. Arch Int Med 167(14)1487-92, 2007
Jul 23
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Management of Age Diversity Faculty Perceptions
of Work Hours
Faculty perceive increased workload and decreased
career satisfaction
Reed et al. Arch Int Med 167(14)1487-92, 2007
Jul 23
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Management of Age Diversity Surgical Education
Data Post Work Hours

• Number of surgical cases done Unchanged
• In-Service Exam Scores Unchanged
• Boomers Reaction See, they have more time off
  and they arent studying enough to improve their
  scores.
• Generation Y Reaction See, we can have more
  time off to have a life and still perform as well
  as before the restrictions.

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Management of Age Diversity Training Generation Y

• They have been managed, nurtured and provided
  with a multitude of diverting activities from
  birth.
• Generation Y is high performance but also high
  maintenance
• They expect ongoing attention and direction
• Impatient with inactivity, bored with
  conventional lectures

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Management of Age Diversity Training Generation Y

• Reared in Postmodern Worldview
• They've grown up questioning what theyre told,
  including by their parents
• Now they're questioning their faculty which is
  annoying to Generation X and Boomer faculty
• Take advantage of skepticism

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Management of Age Diversity Training Generation Y

• They have always been the center of attention
• They were not raised in the children should be
  seen, not heard era
• Theyve been asked their opinion since they were
  two years old
• Theyre vocal and assume everyone values their
  opinion
• Grates on Boomers and older Gen X faculty

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Management of Age Diversity Training Generation Y

• Have been closely managed
• Think Earl Woods
• Expect (sometimes need) a lot of explicit
  direction
• Boomers communicate obliquely Youre
  underperforming and need to pick it up!
• Generation Y expects explicit direction

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Management of Age DiversityTraining Generation Y

• Generation Y has been bred for success
• High expectations of self They aim to work
  faster and better than others
• Have been protected from failure so dont deal as
  well with it
• Can use pride to drive improvement

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Management of Age DiversityTraining Generation Y

• Theyve been praised for every simple thing
  (Great coloring, Nathan!)
• Expect pats on the back for doing what Boomers
  and Gen X consider to be normal parts of the job
• Feeds perception that theyre spoiled
• Heavy emphasis on negative feedback normal for
  Boomers, completely foreign to Generation Y

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Management of Age DiversityTraining Generation Y

• Generation Y expects immediate responsibility
• Want to make immediate impact
• The idea of working your way up is foreign
• Confident and assertive
• No reason every operation in this institution
  cant be done by a resident.
• Boomers and Gen X see as entitled

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Management of Age DiversityTraining Generation Y

• Generation Y is goal-oriented
• Small goals with tight deadlines
• Clear directives, quantifiable outcomes
• Boomers used to yearly reviews

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Management of Age DiversityTraining Generation Y

• Members of Generation Y benefit most from
  hands-on, team-based training as opposed to
  lectures or textbooks.
• Collaborative Raised to work with others much
  more suited to group efforts than Generation X

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Management of Age DiversityTraining Generation Y

• Want to spend more time in volunteerism
• Many programs creating regular rotations to
  underserved areas overseas
• Will often want as tradeoff with other work
• Mayo Clinic International Health Program

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Management of Age Diversity Effect on Medical
Practice

• Faculty lament high rate of fellowship training,
  lack of primary care
• Suggestions Marketing, Shortening Training,
  Increase Salaries
• All lack insight into Generation Y
• Need to adapt to new values

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Management of Age Diversity Effect on Medical
Practice

• Lifestyle considerations are not going away
• Businesses are offering unique packages to
  Generation Y
• Offering perks, such as one-month sabbaticals
  after five years of service.
• Are you paying me to be here or to get the job
  done?

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Management of Age Diversity Effect on Medical
Practice

• Make general practice a part of specialized
  practice
• Make general call a part of specialized practice
• Make general practice lifestyle more appealing
• Generation Y must recognize that some practices
  require more lifestyle sacrifices

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Management of Age Diversity Summary

• Different age groups Different cultures
• Cultures do and will collide
• Generations have to adapt to each other
• Training Generation Y has a lot of risks and a
  lot of opportunities
• Medical training and practice will be changed as
  much by Generation Y as Generation Y is changed
  by their training

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Management of Age Diversity Summary
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Thank You!