Editor’s Corner: Move Over Millennials: Time to Teach Outside the Boundaries

Alexandra P. Wolanskyj-Spinner, MD
Professor of Medicine in the Department of Hematology at Mayo Clinic in Rochester, Minnesota; Associate Editor, ASH Clinical News

The many meanings and purposes of the word “zoom” and its namesake technology are especially relevant in today’s educational environment. To prepare our educators, it is necessary to understand the changing landscape that the pandemic has naturally accelerated, as well as the new generation of learners entering medical education. Until recently, millennials (also known as Generation Y, or people born between 1981 and 1996) were the most prevalent generation in medical schools. Much emphasis has been placed on millennial education. However, most millennials have by now graduated from higher education and are currently in the workforce, and the youngest members are finishing up their undergraduate education.

Much has been written about understanding this generation of inspiring, socially minded yet self-oriented group of learners and how to teach millennial learners effectively. The so-called 5 R’s summarize how to best connect with these learners: ensure a relaxed learning environment, build rapport with learners, highlight the relevance and rationale of learning objectives and assessments, and implement research-based educational methods.1 Competency-based medical education, which combines personal goal-setting and frequent formative assessment, is an ideal fit for these 21st-century learners.2

However, millennials are now being replaced by Generation Z (also known as the neo-millennials), or people born roughly between 1997 and 2015. The older Generation Z members are now entering higher education and will shorty overtake their generational predecessors in medical schools, residencies, and fellowships. Appreciating how neo-millennials view the world – and how this shapes their approach to learning – is essential to optimizing their educational outcomes and preparing faculty to teach effectively the art and science of medicine.

Welcome Generation Z

The true digital natives of Generation Z have been exposed to the internet, social media, and mobile systems throughout their lives. As a result, they can move between virtual and non-virtual platforms with ease.

Generation Z consists of “active problem solvers, independent learners, and advocates for social justice.”3 Medical students in Generation Z are projected to prefer more technological integration into learning spaces than previous generations and hope to use their skills to help solve societal problems entrepreneurially.

Today, medical educators are incorporating existing technological platforms (Blackboard, video lectures, podcasts, etc.) into their curriculum delivery arsenal. Telemedicine and patient tele-interactions are being developed into formalized curricular domains. In addition, technologies such as artificial intelligence are now able to classify simulated and real-life student-patient tele-interactions as “positive” or “negative,” using “master clinicians” as the criterion standard judge. In the future, this type of learning may identify clinical and professional behaviors that can be modeled for telehealth students.4

The consulting firm McKinsey & Company recently termed Generation Z the “True Gen,” based on how their behavior and attitudes affect consumerism and impact the global population.5 In contrast to millennials/Generation Y, True Gens are radically inclusive, externally focused, less confrontational, and less idealistic than their predecessors. All these characteristics are rooted in the common goal of finding truth.

They do not believe in defining oneself through one stereotype but express individual truth through experimenting with different identities over time. They connect to different truths and continually flow between communities. They live pragmatically, with worldviews rooted in realism and high ethical standards. Transparent and open dialogue, therefore, comes easily to them.

Pushing the Boundaries

Today, the COVID-19 pandemic has pushed technological advances into the classroom and the clinic, which happens to align well with Generation Z’s training preferences and patients’ demands for health-care delivery.

Appreciating how Generation Z views the world – and how this shapes their approach to learning – is essential to optimizing their educational outcomes and preparing faculty to teach effectively the art and science of medicine.

Video communication technology facilitates delivery of distance learning, content sharing, and small group discussion, similar to a flipped classroom model in which students review material on their own and return to the online classroom to discuss how to apply the concepts they learned.

Its use in medical education, however, has limitations and will require special consideration. For example, medical educators must create dialogues that allow for sufficient human interaction but also limit the number of participants to ensure that all voices are heard. Video conferencing technologies provide opportunities for abundant discussion with an open mind, moving away from the “sage on the stage” mentality. In turn, moderators and facilitators must be knowledgeable and nonjudgmental.

Medicine lends itself to innumerable ethical questions and is ripe for dialogue with this group of learners – particularly in the context of the complex psychosocial issues that arise in hematology and its patient population.

Quoting Hanna Cody, a digital educator, Master of Public Administration candidate at Columbia University, and “cusper” on the edge of the millennial and neo-millennial periods, this movement “directs learners toward a classroom without boundaries – both in terms of physical spaces and in the relationship between student and teacher.”

As she goes on to discuss, COVID has certainly pushed our understanding of where a classroom and its students can be and perhaps even who a student can be if they are not forced to take on the burden of relocating to attend their school of choice. However, the migration to online learning is only one piece of the puzzle as Generation Z questions the very notion of what knowledge is, what constitutes an expert, and who holds authority over truth.

“It seems inevitable that the future of learning is one where power is shared, knowledge is cocreated, and limits are expanded beyond the physical and hierarchical structures with which we are currently familiar,” Ms. Cody says. “This can be seen either as a challenge to modern pedagogy or an exciting opportunity for professors to engage in teaching and knowledge production in a collaborative, expanded way.”

The boundaries of classrooms have been redrawn and expanded. Today’s learning environment is well suited to small group discussions, which emphasize the ground rules of professional and respectful behavior. Moderators can elegantly balance vigorous debate with ethical standards, principles of inclusion, and a growth mindset for all.

Whether we are baby boomers, Gen Xers, or millennials, this “Generation Zoom” moment can be seized as an opportunity to evolve as teachers and faculty. We, too, must be willing to be pushed outside of our own comfort level and boundaries. The best of one generation can bring out the best in another. So, leave the complex technology up to them; just show up with an open mind and an open heart. It’s time to zoom into this next phase of medical education.

Alexandra Wolanskyj-Spinner, MD
Associate Editor


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  3. Eckleberry-Hunt J, Lick D, Hunt R. Is medical education ready for generation Z? J Grad Med Educ. 2018;10:378-381.
  4. Marshall AL, Wolanskyj-Spinner A. COVID-19: challenges and opportunities for educators and Generation Z Learners. Mayo Clin Proc. 2020;95:1135-1137.
  5. McKinsey & Company. ‘True Gen’: Generation Z and its implications for companies. November 2018.