Before you roll your eyes at yet another annoying millennial demanding a "safe space," let me be clear: We get it. Medicine is tough. Despite the "participation trophies" lining our bedrooms, we know that we are committing to a lifetime of hard work and self-discipline. That is not lost on us. Doctors in practice for decades have witnessed a shift from what they endured during their medical education. One hundred–hour workweeks, errand runs for senior staff, and copious "scut" work have declined in the face of shifting attitudes regarding the treatment of medical trainees. Today's students largely reject the notion that the training culture of the past made doctors "tougher" or "better." In fact, it may well have laid the foundation for the current, well-recognized epidemic of physician burnout. This rejection of abuse and mistreatment by today's trainees has, sadly, led many current practitioners to feel as though they have to tiptoe around my generation's fragile sensibilities. A recent publication in JAMA Pediatrics suggested that teaching medicine now requires "walking on eggshells." This appears to be a commonly held belief. Take a scroll through the comment section of virtually any article that addresses concerns about medical trainee well-being and you'll see established doctors who express anger and frustration with criticisms put forth by this generation. I'm frankly concerned at some of the language posted to public forums with commenters' names attached. As a current student myself, I certainly don't have all of the solutions to closing this increasingly hostile generational divide. I do believe that bridging the gap is crucial and that it starts by finding common ground, beginning with a shared understanding of what mistreatment actually looks like. 'Suck It Up, Buttercup' Although it dates back nearly 30 years, I like Dr Henry Silver's definition of medical student abuse: "unnecessary or avoidable acts or words of a negative nature inflicted by one person on another person or persons." How does that work in practice? Well, everyone—I hope—recognizes physical threats and abuse as inappropriate and rightfully discouraged. Verbal abuse is far more of a gray area. Significant disagreement centers on what constitutes verbal abuse in the training setting and just what to do about it. In a culture where "pimping" is an acceptable term, where do we draw the line on appropriate communication? Many doctors without the "millennial" label can recall their experiences being on the receiving end of descriptors like "stupid," "worthless," and others that are normally printed as a series of asterisks... Speaking solely from my own and my friends' experiences, those moments are a rarity today, but exchanges that leave students feeling miserable about themselves still occur. Some in the old guard brush off these exchanges, thinking, I went through worse and survived. What's the big deal? This attitude can be summed up as "Suck it up, buttercup." However, just because previous generations experienced this treatment, why should we still allow for public humiliation or childish insults? What may seem harmless to a senior doctor now may be a demoralizing experience for a medical student that can be avoided. Students are wrong. A lot. We are still learning. As we present patients during rounds or answer questions during a procedure, we'll inevitably mess up. At this stage, our education involves exposing mistakes by speaking them out loud, as opposed to clicking the wrong bubble on a test. This real-time correction can be very intimidating for us. My best teachers have mixed clinical pearls with funny anecdotes, witty mnemonics, and passion for the material; that's the kind of positive environment in which education flourishes. The Millennial Achilles' Heel It is important to remember that our perspective as medical students is heavily influenced by the fact that most of us have never had a "regular" full-time job. We have shuffled from one classroom to the next for 20 years. As a result, many of us are actually much more comfortable with structure and authority than the progressive tendencies often attributed to our generation would suggest. Therein lies the millennial Achilles' heel. Because of our limited experience outside of academic environments and lengthy time inside of them, many of us assume that every single conflict must be mediated through third parties, that others must see our points of view as intrinsically valid, and that any pushback from others must come from a bad place. Part of bridging the generational gap means that we must reevaluate our expectations in those areas. We must learn to adapt to realities, such as the fact that two students can have widely different experiences with situations such as our schedules. For instance, if the outpatient setting feels like torture, staying late after a packed schedule can seem even more maddening. Attendings may single out a student to write notes and assist with office-based procedures, things that no one else on the block was "forced" to do. Some consider this to be mistreatment because study time gets eaten up, and they may then submit negative evaluations of their attending. I believe that these students are mistaken. Beyond the requirements in the syllabus, it is perfectly acceptable for faculty or residents to request our involvement with routine tasks, so long as patient care is not compromised and work-hour restrictions are not violated. Clinicals are meant to serve, in part, as a trial run for residency, where the workload will not always be spread evenly among peers. These are the kind of irritations that we must learn to distinguish from injustices. Making Each Other Better Finding a happy medium between veterans and rookies always generates friction. Each approaches medicine with widely different experiences and proclivities, but that's what makes the job exciting and dynamic. Seasoned doctors recall charting on paper while their younger counterparts accessed computers as children and operate ultrasound probes with relative ease. To those who discredit the grit of millennials, please understand that we're just as committed to our education as you were. We want our role on the team to reflect the full scope of our knowledge and capabilities. We're learning, yes, but part of that means we want you to positively challenge us instead of putting us in a corner or avoid teaching us responsibilities altogether. That's not to say that the onus rests solely on those in positions of power. We students must meet this test head-on. Every day in the clinic or on the floor presents the opportunity to hone interview skills, broaden differentials, and build basic techniques. If we mess up, we should own it. Experienced docs and the next generation should both try to remember that we all ultimately want the same thing. Source
