Life - Do med students have one? Work-life balance across generations

I gave a journal club last week discussing some general ideas about generational differences between the three main groups trying to work together in medical education: Boomers, Gen X, and Gen Y (or whatever it is your preferred term for this generation is).  As I was looking into the topic to prepare for this talk, one of the themes that kept popping up was the work-life balance theme.  In general, the common wisdom is that the Boomers value hard work, and are willing to sacrifice family life for career advancement.  Gen X and Gen Y tend to have less of a focus on work as a source of primary identity, and see much more value in maintaining balance between career and home.  The purpose of this blog post is not to decide whether this is indeed true or not.

What I'd like to spend a moment discussing is how this generational difference is creating conflict in the halls of medical schools.  Medical students are primarily Gen Y (although there are some Gen X in the mix).  Faculty who now populate Dean's office level positions are primarily Boomers, and course/clerkship directors are now Boomers with some Gen X filling the junior ranks.  So, what happens is that the Boomers remember their medical school life which was ruled by the Greatest Generation (even more value on work due to their experiences in the Great Depression).  The biggest place I've seen this conflict play out is in requests for time off or for changing a date to take a test.  The Boomers were given very little room to change their schedule.  I've talked to many of them, and the stories were essentially that if you wanted to take a day off during the clinical years for anything other than being near-death, there would be severe consequences (like repeating the entire clerkship).  Things were a little better for me, but not a lot.  I remember having friends in medical school who had a lot of trouble getting time off to attend weddings or family reunions.  There was minor grumbling, but we all decided it was a transient time, and this was preparing us somehow for the trials of residency.  And we kept telling ourselves that things would eventually get better.  We also had the usual weeks of vacation around the Holidays and Spring Break for some time off.  Everyone also had some lighter rotations, and the fourth-year comes with a much more flexible schedule.

Then along comes Gen Y.  They are much more vocal about their need for time off, and much more vocal about providing feedback on things that they are not in agreement with.  And they are now complaining primarily to the Boomers, who primarily don't want to hear about it.  I'm not so sure.  Maybe it's my Gen X roots showing or maybe I'm still close enough to being a student that I remember the bind it puts you in if your schedule is completely inflexible.  So, I'm wondering if maybe school policies for personal days off should be revisited.  I'm thinking most of the policies were set in place for a very different world, and haven't been changed much for 20-30 years.  With the advent of technology, it is possible to make up some assignments which may not have been possible to make up in the past.  There's also a different cultural norm emerging (or maybe I just think this should happen), and missing a wedding because you are assigned to spend a day in clinic is not an acceptable trade-off.

As a disclaimer - I've been told by several fourth-year students that as a clerkship director, I run a 'tight ship'.  To my mind I'm just doing what the school time off policy is telling me to do.  Our school policy is that student have 2 days off per year which can be used for attending a professional meeting or if they are ill/ have a family emergency.  All other time off is at the discretion of the clerkship director, and must be made up.  I'm not sure I have a perfect answer as to how to change the current policy, but maybe working with appropriate representatives from Gen Y, Gen X, and Boomers we can work together to figure something out.

What medical education can learn from "Moneyball"

I've been waiting a bit to write this post, as I'm not sure exactly which way to take it.  Let me start by stating that I'm a really big baseball fan, and have been since second grade when my dad first took me on the El in Chicago to see the Cubs play in Wrigley.  I still get chills walking into that place.  This love of baseball drives me read the occasional baseball book.  So, while I haven't seen the recent movie, I read the Michael Lewis book, "Moneyball," a few years ago.  And I really liked it on many levels.

In the realm of medical education, I liked the idea of trying to measure something that is inherently immeasurable.  In some respects, trying to pick a good candidate from a pool of medical school applicants or trying to assign a grade to a student on a clinical rotation is not unlike what the old-time scouts in "Moneyball" were doing.  They would look at a player batting, pitching, or fielding, and go with an overall geschalt of whether that player was 'big-league material'.  They were also basing their decisions on statistics which had been around forever, and no one had ever really questioned whether they worked or not to predict who is or who is not going to be a good performer.

Then, Billy Beane and his team of statisticians looked beyond the traditional numbers and redefined what to look for in a player prospect by largely ignoring the players current body habitus or mechanics and focusing solely on the numbers.  They also redefined what success was by finding the the number of runners on base per game correlated to wins more tightly than other statistics.  Thus, on-base percentage, and slugging percentage (which measures walks with extra-base hits) was more important for how an individual would contribute to the team than total runs batted in or home runs.  (Sorry if I just lost the non-baseball fans out there).

This process can have applications to lots of venues.  I think medical school needs to re-look at how we are evaluating our students and decide if we need to go through a similar process.  Are there statistics available to us now which may not have been available 20 to 30 years ago that we could use to identify medical students who are not likely to do well in practice.  We're pretty solid at identifying people with knowledge gaps as our system of standardized testing takes care of that.  But, is that what really makes a good physician?  It's a part of it for sure, but it is not all of it.  There's a lot more to clinical reasoning, and professionalism than just knowledge base.  Can we find ways of identifying ways to capture those measures, or are we going to be stuck with the old scouting reports and crossing our fingers to see what happens?  I don't have any solid answers yet, but I'm willing to help look.