The emergency department can be a scary place. On some days, it can be so calm that we offer prayers of gratitude to the Almighty. This is called a bonus call for doctors. On other days, however, it can be total chaos. A catastrophe that makes you want to break down in tears. On these types of days, doctors from other units or departments are usually called to lend a hand in sorting out the patients.
A few weeks ago, a paediatric emergency unit experienced a similar pandemonium. The unit head asked for extra helping hands, especially from junior doctors in the department. Admittedly, some rushed to the hospital, eager to help, but a few others did not. When asked the reason for their absence, one young man in particular, looked the older Professor in the eye and said:
“It is not within my scope of duty. I came to work only in the paediatrics out-patient clinic and not in the emergency unit.”
The old man was shocked at the audacity of this young chap.
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Needless to say, the young doctor received a severe verbal thrashing that he will never forget.
Welcome to the gen Z generation.
During the recent MDCN licensing examination for International Medical Graduates (IMGs), I observed their demeanor and performance with a mixture of admiration and disgusted shock. Gone were the ties and smart dressing of my generation. In their places were casual button down shirts, baggy jeans, fancy haircuts, track bottoms and wrinkled labcoats. They swaggered into the exam halls looking downcast and absolutely lost. Before the start of the exams, I had a chat with a few of them and heard their stories.
“I really want to pass my exams”
“My parents forced me”
“It does not really bother me. I am not into clinical practice. This is just to fulfill all righteousness”
“I am an entrepreneur. I am getting my MBA after this.”
Their audacity and boldness gave me goose bumps. A part of me admired their clarity and dreams, but another part laughed inwardly at their youthful foolishness. They had big goals but were naïve enough to believe that the world would just adjust to their whims. In their minds, the odds would forever be in their favour.
Gen Z has yet to be assigned a definitive age range but it mostly refers to people born between the mid-1990s and the mid-2000s, so the generation’s oldest members are now in the workforce.
In a study by Stillman and Stillman of Harper Buisness school, members of Generation Z were found to expect customisation, or an “a la carte” approach to education. This generation does not see the value in going into excessive debt for a college education, and may view some courses as impractical or irrelevant to their ultimate goals. They expect customised experiences for the best use of their time and resources. Generation Z also prefers more hands-on experience and on-the-job learning, as well as customised feedback. They prefer not to spend long periods of time listening to lectures. Instead, they want to know what is needed to succeed in the moment, mirroring their experiences with social media. In Naija slang: They want to know now-now and “blow sharp sharp”. They do not believe in the dignity of working hard but instead emphasise working smart. These are a generation of youth who have figured out how to code, trade forex and design apps, do remote jobs and therefore earn money from a very young age.
Not for them our wahala lifestyle!
From Flutterwave to KudaBank to Piggyvest to Flying Doctors to Bella Naija to Andela and even Linda Ikeji, all these are companies that have either gen Z as founders or CEOs. And these are just buisnesses; as for the music industry, this generation has since established Nigeria on the map. From the Headies to Grammy’s to outstanding performances at world cups stages, this generation has proved that they are determined to get ahead, respect be damned.
They are the first generation to have always had the Internet and social networking; technology has been ubiquitous. And because Generation Z has spent so much time with electronic communication and so this may affect in-person communication skills. Educational programs should therefore assess learners’ communication skills early in medical training and be prepared to work with individuals who struggle with this competency. Role playing, direct observation, and self-reflection may prove useful remediation methods, but immediate feedback on performance will be essential. Generation Z already have poor tolerance for delays in “knowing” how they are doing. Educators will need to provide very clear instructions and not assume that these learners can pick up more subtle forms of feedback, which may have been the mainstay in previous generations.
At the same time, Generation Z is the most diverse generation in history in terms of race, gender, religion and sexual orientation. They are not afraid to demand equal rights in the workplace as they have grown up observing diversity around them. Whenever, I attempt to discuss racism around my children, I am always met with confused faces. ‘But why, mama? Why do they not like black people? Are you sure of this?’ Their young minds cannot comprehend racism because they have never experienced it. All around them are biracial couples and mixed children who are friendly, well behaved and indifferent to the colour of their skin.
Addtionally, generation Z consists of active problem solvers, independent learners, and advocates for social justice, fairness, equality, and the environment. See Greta Thunberg. They are more likely to advocate for climate change and issues pertaining to social change. They are more open about their sexual orientation that we would like to admit. Even in conservative countries like Nigeria, there are more and more cross dressers coming out on social media boldly speaking about their way of life.
Truth is we need to come to terms with this generational gap.
What about the field of medicine? What do we do?
The good news is that we have a little time to be thoughtful about changing medical education to successfully recruit, train, and retain Generation Z physicians. The bad news is that we have only a little time to make these changes. Historically, medical education has been resistant to reform—and for good reason. At the end of the pathway are patients; we need to find the best teaching tools that promote the best delivery of care. There is always room for improvement, but change should be guided by theory and not simply tradition. The military training of demanding respect and absolute submission to medical elders during residency training will have to be amended. Already less and less doctors are specialising, preferring instead to go into research and public health where the money is, becoming enterpreneurs or harnessing the power of social media to attain fame and opportunities. Moreover, until the difficulties that contribute to current career dissatisfaction among physicians are addressed, it is not likely that the highest performers within Generation Z will be recruited and retained.
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