Should Generational Characteristics Be Considered In Instructional Methods? The Instructional Preferences Of Millennials And Its Implications For Medical Education
B Boateng. Should Generational Characteristics Be Considered In Instructional Methods? The Instructional Preferences Of Millennials And Its Implications For Medical Education. The Internet Journal of Medical Education. 2010 Volume 2 Number 1.
Medical educators are faced with the challenge of improving the effectiveness of didactics for the incoming generation of medical students and residents, most of whom are Millennials. The objective of this study was to determine whether generational characteristics should be considered in instructional design. 4th year medical students and residents in a southern medical school in the United States were asked to rank what they considered important instructional practices in a classroom or clinical setting. Non-parametric statistics were used to analyze the data. Lectures combined with group work and discussions were ranked as the most preferred instructional format, regardless of generational cohort. Males were more likely to prefer learning procedural skills whereas females preferred learning communication skills. Irrespective of generational characteristics, sound instructional practices should be employed for effective learning.
Lecture-based instruction continues to be a preferred format in higher education, although pedagogical research has questioned the effectiveness of this format1. Medical school faculty, who have large volumes of material to teach, also have to find ways to engage their learners through meaningful interactions. Therefore, an important challenge to educators is how to improve the effectiveness of didactics while incorporating techniques that would enhance critical thinking and active learning among students.
With the changing dynamics in higher education and an increasing population of students born after 1981, studies are beginning to focus on the characteristics of the incoming generation of college-bound students and how that will affect pedagogy. Some studies have emphasized the educators perspectives on effective instructional practices 2, 3 and few have reported on student perspectives on effective instructional practices4, 5. Even fewer studies have examined medical student and residents perspectives on instructional preferences in the classroom and clinical settings.
Medical education is particularly challenging in that learners not only have to acquire facts but they also have to be competent practicing physicians by obtaining medical knowledge and practicing evidenced based medicine. This transfer of knowledge and drive for competency is further complicated by generational differences and opinions on effective instruction.
The following generations can be found at medical schools6-8.
The silent generation, born between 1925 – 1942, presently occupy many administrative, faculty, and decision making positions that affects how instruction occurs.
The baby boomers, born between 1943-1960, are mostly faculty and program directors, who may be responsible for the overall curriculum.
The genXers, born between 1961-1974, are clinician-educators, faculty, and residents who were and are being taught by the baby boomers. GenXers tend to be independent, self reliant, and skeptical.
The cuspars8, born between 1975 – 1980, are those that have characteristics of both genXers and millennials.
The millennials, born between 1981 to 1999, represent the incoming pool of medical students taught mostly by baby boomers and genXers. Millennials tend to be multi-taskers and perfectionists, are sometimes viewed as lazy because they have been raised to expect extra help and additional resources when faced with educational struggles.
GenXers and cuspars mostly occupy residency programs and millennials are the incoming class of medical students. The question that arises is that, should generational characteristics be considered in medical school pedagogy? This study sought to investigate whether generational characteristics of the four groups (baby boomers, genXers, cuspars and millennials) played a role in what was perceived as important instructional strategies and behavior in a classroom and clinical setting in medical education centres.
It examines generational differences in instructional preferences for clinical and classroom teaching, and its possible implications for academic medicine. The study was conducted under the hypothesis that there will be no generational differences in instructional preferences in clinical and classroom settings. This is based on the premise that effective pedagogy is not determined by the discourse on generational characteristics.
This study took place in a United States southern medical school in 2007. All fourth year medical students and residents (at different stages of their residency program) were invited to participate in the study. This population was chosen because they had experienced a variety of teaching methods in the classroom and clinical settings. They also represent different generational cohorts.
This inquiry was quantitative in nature. An instrument was developed based on research on student perspectives on instruction in higher education2, 4, 5,9,10. The survey consisted of two parts. Part A focused on demographic information such as gender, age group, PGY level and where they completed medical school. Part B consisted of the four sub sections with ranking items. The subsections were: teaching behavior in a classroom setting, instructional format in a classroom setting, teaching behavior in a clinical setting and instructional format in a clinical setting. Each section had 5 statements related to instructional behavior and format (appendix 1). Participants were asked to rate the importance of each item on the four sub sections on a five point ranking scale from least important to most important.
The instrument was reviewed by three medical educators and a resident physician who provided feedback on the clarity and appropriateness of statements. Participants were requested to anonymously complete an online survey administered through Survey Monkey™. The Institutional Review Board (IRB) approved this study.
Non-parametric statistics for ordinal data was used to analyze the data. The Kruskal-Wallis test was conducted to determine generational differences in ranking of important teaching behavior and instructional preference in classroom and clinic settings. Follow-up tests were conducted to evaluate pair wise differences between the three generations using the
Of the 487 email addresses obtained, 160 participants completed the survey. The survey response rate was 32.9% after four reminders over a 6 month period. Demographically, there were more males (61%) than females (39%) at the medical school (table 1) and the largest percentage of respondents were cuspars (58%).
The following teaching methods were ranked as the three most important factors in each category, regardless of gender or generation.
Teaching behavior in a classroom setting
Gives clear explanations/reasons for opinions, advice, actions, etc.
Shows enthusiasm and interest in teaching.
Asks questions that promote learning (clarifications, discussion-generating questions, reflective questions).
Instructional preference in a classroom setting
Lectures supported with visual aids (PowerPoint, slides, video, etc.).
Online instruction mixed with face-to-face lectures (hybrid classes).
Lectures with student discussions/group work.
Preferred type of clinical teaching that is important
Adjusts teaching to diverse settings (bedside, view box, OR, exam room, microscopes)
Coaches me on my clinical/technical skills (interview, diagnostic, examination, procedural, lab)
Teaches diagnostic skills (clinical reasoning, selection/interpretation of tests)
Type of teaching behavior in clinical setting
Practices ethical medicine
Encourages evidence-based medicine
Provides opportunity for learning procedural skills
Since baby boomers were a small sample (1% of respondents), it is not practical to make any valid inferences about their preferences. There were, however similarities in what was ranked as important amongst genXers, cuspars and millennials, and differences were minimal. There were generational differences with regards to role modeling as a teaching behavior and lectures with student discussions and group work as a teaching format. Cuspars were more likely to rank role modeling as important compared to genXers and millennials (p = .027). This pattern was reversed with regards to lectures with student discussions and group work as a teaching format (p = .019). GenXers and millenials ranked those as important compared to cuspars.
GenXers, cuspars and millennials are often viewed as technically competent generations and it was interesting to determine whether online learning would be an important instructional strategy. 90.6 percent of genXers, 82.6 percent of cuspars and 91.2 percent of millennials ranked online instruction as an exclusive instructional strategy as the least important instructional method. This pattern was reversed with regards to lectures with visual aids such as PowerPoint™ with 65.6 percent of genXers, 66.3 percent of cuspars and 58.8 percent of millennials ranking it as the most important teaching strategy.
There were no gender differences on most of the items except three behaviors in the classroom and clinical setting. There were significant gender differences with regards to learning procedural skills, asking questions that promote learning and an instructor that teaches effective patient and/or family communication skills. Regardless of generation, males ranked learning procedural skills (p = 0.012) and asking questions that promoted learning (p = 0.000) as important instructional behaviors in a classroom and clinical settings. Females ranked teaching effective patient and/or family communication skills as important in the clinical setting (p= .002).
Discussions and Implications for Medical Education
The existing body
The findings of this study are supported by a small but growing body of research on the instructional preferences of millennial learners. Similar findings are reported by Roberts14 who conducted a study on higher education students at the University of Pittsburgh and concluded that 50 percent lecturing and 50 percent interactive activities was the most preferred instructional method in a class room setting. Walker15 also concluded that there were no generational differences in nursing students’ preference of instructional methods. While some studies16 indicate that millennials are more likely to use technology, this study reiterates that technology is a tool that can be used to achieve effective learning, and it is not the solution. Learners expect instructors to use the technology to communicate expert knowledge14. Therefore, instructors (be it in a classroom or clinical setting) need to be cautious about developing educational practices based on popular discourse on generational characteristics. Irrespective of generational characteristics, sound instructional practices should be employed for effective learning. It would be good educational practice for instructors to focus on engaging their learners by creating learning experiences that are active, are relevant to the learner, involve concrete experiences, and take into consideration the learner’s background and learning style. Until there is more research completed that explores the generations and their preferences for learning, it behooves the instructor to continue to follow reliable and effective instructional practices based learning theories.
Regardless of generation or gender, respondents indicated a preference for lectures and hybrid classes when compared to online instruction. They also preferred an instructor who facilitated learning by providing clear explanations and showed enthusiasm. Noteworthy is that exclusively using group work or online learning were amongst the least preferred instructional methods, irrespective of generational group. This is an interesting observation since popular rhetoric indicates that genXers, cuspars and millennials tend to be technologically competent and would prefer learning activities that harness social interactions. Their preferences could also be attributed to the profession. Medicine is a hands-on profession and online learning may not be important or a preferred instructional method for teaching practical skills. Respondents generally preferred instructors that were able to adjust their teaching in diverse clinical settings and also encourage evidence based medicine. Gender differences were found with males generally having a preference for procedural learning while female tend to prefer acquiring communication skills.
The gender difference in preferences for communication skills echoes the findings that concluded that, when learning new information, females tend to prefer regular feedback and reassurance compared to males17. Also, there is some evidence that suggests that female medical students tend to have higher positive attitudes towards communication skills training18 and thus female physicians tend to exhibit more patient centered communication behaviors17. Cambiano
Limitations of this study included the use of self-reported data, a low response rate and the potential for response bias from medical students and residents. While this study is not generalizable as it was conducted in one school with a limited population, it provides us with insights and the need for further investigation into the role of discourse on generational characteristics on effective pedagogy. Further discussions and studies are needed on preferences on methods of instruction as online instruction would not be affected only by personal preferences, but also by the structure of the course, and the quality of the instruction. There is a continuous need for the development of innovative pedagogical practices that complement the learning needs of learners.