Generational differences result in conscious and unconscious biases that affect day-to-day interactions among professionals in the field of pediatrics. From the millennial trainee to the baby boomer seasoned clinician educator, including the three authors of this article, who span three generations, all are guilty to some extent. Pediatricians are not alone. In fact, some of them may even be in “exalted” company:
“They [Young People] have exalted notions because they have not been humbled by life or learned its necessary limitations; moreover, their hopeful disposition makes them think themselves equal to great things, and that means having exalted notions. They would always rather do noble deeds than useful ones. Their lives are regulated more by moral feeling than by reasoning. All their mistakes are in the direction of doing things excessively and vehemently.”
Aristotle1
Every day, multidisciplinary teams of pediatric health care professionals converge in a clinical setting, hoping to create a psychologically healthy workplace where all generations feel included and valued in patient care discussions. Nonetheless, although health care team members in the field of pediatrics intentionally work to remedy the generational differences that arise between parents and their children, generational comparisons persist.
We all are products of our own generational upbringings and the events that shaped our own lives, which, in turn, lead to perceptions about other generations that may or may not be true. We then may treat others accordingly (both consciously and unconsciously).2 Some of these generational biases may be apparent, whereas others may be subtle and/or intertwined with other forms of biases. We would like to propose a more holistic approach3 for pediatric clinicians similar to ones we implement when working with multigenerational families. This construct, focused on generational empathy and rooted in strategies to address implicit biases,4–6 will help us as pediatricians to recognize, reflect on, and minimize both generational and other potentially harmful biases. It is our intent that this approach will provide an effective strategy to eliminate, or at least mitigate, biases so we can concentrate on our ultimate purpose: improving the health and well-being of the children we care for together.
To achieve this goal, we offer three tenets all of us, regardless of generation, can embrace and implement. These tenets are ones that we, as individuals who span three generations, consider to be applicable to the clinical setting, in which patient care, teaching, and learning occur on a daily basis. We propose that they can help diminish generational biases.
Every member of a health care team desires to provide the best care possible for their patients.
Every member of a health care team should be valued for their contributions.
Every member of a health care team has unique life experiences, skill sets, and perspectives that should be valued.
Each principle highlights the inclusive and diverse strengths of each generation, which should be synergistic rather than antagonistic to each other in a clinical setting.7,8
Principle 1: The Desire to Provide the Best Care Possible for Our Patients
In a pediatric clinical setting, the teaching of trainees to deliver optimal patient care has been transformed by innovations in best-evidence medical education. We now use individualized learning plans, bidirectional feedback systems, and new educational technologies, such as audience response systems, wikis, and podcasts, to render learning more efficient and effective. Such newer approaches to learning may conflict with how another generation was taught. For example, most physicians currently practicing were trained through didactic lectures and textbooks, which were vital educational tools in developing physicians at the time but play less important roles in the educational development of today’s physicians. As many of us have witnessed, the choice of a learning modality is often based on generational experiences and potentially creates friction rather than cooperation among learners in common pursuit of knowledge. Such generational differences can lead to multidirectional conflict within modern health care teams, propagating even more generational biases. If we recognize these types of generational differences and begin with the assumption that we all desire to provide the best possible care for our patients, we can open ourselves to cross-generational learning experiences that can improve patient care. On the basis of this tenet, we propose that, instead of reinforcing generational biases rooted in how we each learned to practice pediatrics, we consider how each learning strategy might contribute to creating and sustaining an overall desire for lifelong learning (one that might require a textbook on one occasion and a simulation exercise on another). Perhaps it is time to jointly download that podcast while picking up the copy of the textbook in the workroom and thereby pool our knowledge to provide our patients the best care possible.
Principle 2: All Members of the Team Need to Be Valued
Regardless of one’s generation, everyone has a deep-seated need to be valued for their contributions to the team.9 We all agree that the health care system today is markedly different and more complex compared to the world in which many practicing physicians trained, and the patients themselves also reflect that complexity. For example, the time and skills needed to document and code properly by using a new electronic health record system, expedite discharges, ensure adequate productivity metrics, adhere to care pathways, and always strive for a family-centered approach are challenges that have evolved over the years. These requirements (in addition to many others) have resulted in significant changes in the training of pediatricians, which can lead to generational biases. We would assert that attempting to compare pediatric residency training today to that of years past is often unproductive and, at times, harmful. Disparaging wide-sweeping generational comparisons as they relate to training often afford missed opportunities to bring together different generations, with mutual respect and understanding, to provide optimal care of a patient. Also, such comparisons, which can directly or indirectly devalue a member’s contributions to the team, often result in a less effective and/or engaged team member. Overall, the goal is for each member of the team to feel connected, respected, and valued for their contributions to the care of a patient.9,10 We recommend addressing the inherent stressors in medicine together, exhibiting empathy to other generational groups, and sharing what brings each of us joy as a team. Doing so builds connections, quashes implicit biases, and ultimately celebrates the inherent strengths that different generations can impart to each other.
Principle 3: Recognize the Uniqueness of Life Experiences, Skill Sets, and Perspectives
Medical students now matriculate at various ages with diverse academic and personal backgrounds.11 These individuals also bring unique sets of skills, life experiences, and perspectives that are pertinent and valuable when properly used in a team-based setting.12 These diverse contributions should be recognized and embraced to enhance the myriad assets a team-based approach to care can provide to a child and family. Unfortunately, it is easy to dismiss the experiences and diversity of another generation in our day-to-day professional duties. For instance, more traditionally trained physicians have a wealth of experiences, talents, and skills that may be underappreciated by younger learners. Similarly, the pediatric resident who was an emergency medical technician or teacher for several years before attending medical school can offer perspectives on addressing the challenges of emergency situations with patients in the field or how we might more adequately provide educational services for children with special needs in the classroom. How unfortunate if the rich diversity of the members who compose our modern health care teams goes under-recognized because of underlying generational biases, resulting in missed opportunities for learning from one another and, possibly, suboptimal care for our patients. Taking time to learn about others’ backgrounds, interests, areas of expertise, and personal interests will provide the basis for appreciating, rather than overlooking, the wealth of knowledge that can be pooled to better build strong teams and provide optimal patient care.
Although the three principles outlined in this narrative should be considered self-evident and core values of the profession, in our busy world and often hectic lives, they unfortunately are often not considered intentionally in many multigenerational clinical settings. We hope that, by outlining them explicitly, we will raise awareness and lead us as team members to demonstrate empathy and avoid criticizing or labeling the behavior of others on the basis of their generational differences. We seek to create an environment that exemplifies diversity, inclusion, equity, kindness, and respect that not only improves the care we provide to patients and families but also protects us from succumbing to negative feelings or behaviors. This desire requires a culture of intentionality and humility and a shift from an “us” versus “them” mindset. Let us together continue to examine, reflect on, and replace the generational biases in the workplace with a generational and cultural empathy that will help us all achieve our ultimate goal: improving the health and well-being of the generations of children, past, present, and future, whom we care for together.
Acknowledgment
We thank Dr B. Lee Ligon (Department of Pediatrics, Center for Research, Innovation and Scholarship, Baylor College of Medicine) for editorial support.
Dr Pulcini drafted the initial manuscript and reviewed and revised all subsequent drafts leading to this article; Drs Turner and First reviewed and revised the initial draft and contributed with ongoing review and revision to all subsequent drafts leading to this article; and all authors conceptualized and designed the piece, approved the final manuscript as submitted, and agree to be accountable for all aspects of the work.
FUNDING: No external funding.
References
Competing Interests
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
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