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Doc, forget the generation gap in learning

The other day, a colleague stopped me in the corridor and started bemoaning the clinical immaturity of his junior doctors, their lack of commitment and dedication, and how things did not use to be so bad when he was a junior himself. In the same week, I heard that resident doctors often felt their seniors were too critical and showed little appreciation for their effort and contribution.

A healthy and nurturing relationship between senior and junior physicians will promote the critical process of role-modelling to create a training experience that will produce good doctors, says the author.

A healthy and nurturing relationship between senior and junior physicians will promote the critical process of role-modelling to create a training experience that will produce good doctors, says the author.

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The other day, a colleague stopped me in the corridor and asked if he could talk to me about his junior doctors.

The conversation divided along the line between long exasperated monologues on his part, and grunts of approval - more often of doubt - on mine.

He was bemoaning, as all of us who care about our work and colleagues should, the clinical immaturity of the juniors, their lack of commitment and dedication, and how things did not use to be so bad when he was a junior himself.

He did not quite define what he meant by “junior”.

He also touched on how difficult it was nowadays to give honest feedback to them, how fragile their egos were, and how hard the seniors had to work these days because of all of the above.

I appreciated the frank discussion. But what bothered me was that he attributed the problems not to deficiencies he had observed in certain individuals or the system but to a group of people loosely defined as “the juniors”.

I would like to say that the substance of his jeremiad, the blanket indictment of a whole generation, was an old song that had been sung many times, and by every generation.

In the same week, I heard that resident doctors often felt their seniors were too critical and showed little appreciation for their effort and contribution.

There were concerns that this was starting to adversely affect the morale on the ground. But, again what was meant by “senior” was never really said.

I don’t know what the truth is. It probably lies somewhere in between.

One way of explaining this awkward relationship between the two groups is the so-called generation gap, like the age-old divide between parents and children.

But the gap seems to be so narrow nowadays that you can be the junior one moment, and the senior the next.

I think established physicians should avoid defining excellence as being “just like ourselves”. They should be more willing to forgive younger physicians struggling at the beginning of the learning journey, and nurture the process.

But, importantly, they must not feel inhibited about pointing out, clearly, fairly and sometimes even bluntly, deficiencies and areas for improvement when they observe them. Younger physicians need to have the courage and confidence to receive honest and well-intentioned feedback, and not perceive them as the “rules of life” imposed by the previous generation.

They should learn that appreciation and support from their peers and juniors are not less significant than those of their seniors, especially in a workplace where the more established physicians, being from a different generation, are usually not as effusive in expressing their appreciation for excellence.

A few years ago, I attended a rather thought-provoking talk at a medical education conference.

The speaker who spoke on the outcomes of residency training started by asking “What should we mean if we say a residency programme is good, or better than another programme?”

He answered his own question by stating that: “…good programmes are those that produce graduates who take care of patients well, and better programmes are those that produce graduates who take care of patients better.” He implied that everything else in between really did not matter too much.

The speaker went on to ask the educator audience three questions: when it comes to our performance as doctors,

1.             Does baseline capability matter?

2.             Does experience matter?

3.             Does where you trained matter?

If all that matters is baseline capability, medical schools and residency programmes should only focus their energy on recruiting the most talented trainees; if all that matters is experience, we should all train longer to be safer doctors; if all that matters is where you trained, we should all scramble to get into programmes with the best track records.

The speaker tried to answer these questions using evidence from obstetrics and concluded that which residency programme an obstetrician came from was strongly associated with maternal complications. So it would seem that where you trained mattered most.  

The role models and workplace culture that physicians-in-training are exposed to in their formative years do have a strong influence on how they turn out.

If this is true, scepticism and suspicion between physicians of different generations may eventually prevent our trainees from becoming the kind of doctors we want them to be.

A healthy and nurturing relationship between the established and younger physicians will promote the critical process of role-modelling to create a training experience that will produce doctors who are exemplars of the high ideals of the profession.

At the end of the day, physicians across all generations have far more experiences that unite than divide them.

The wonder, privilege and honour of being someone’s doctor is one.

 

ABOUT THE AUTHOR:

Dr Khoo See Meng is Chairman of the Medical Board at Alexandra Hospital and Associate Professor at the NUS Yong Loo Lin School of Medicine. He is Head of the Division of Acute Care at the National University Hospital and a specialist in respiratory and critical care Medicine.

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