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Generation Z: What’s Next?

The current generation of learners in medical education, Millennials, has been extensively characterized. This work has helped to inform teaching innovation and curricula over the past decade. However, a new generation will soon enter medical school—Generation Z (Gen Z).

Gen Z, known by a variety of monikers including iGen, Plurals, Founders, Pivotals, and the Homeland Generation, is made up of individuals born from around 1990–2010. This group makes up the largest percentage of the US population and is the most diverse to date. This, combined with the large amount of discretionary spending money at their disposal, has led to their intensive study by the business sector [1]. Even this early in their lives, it is apparent that Gen Z students are not simply young Millennials.

It is necessary to review the origins of commonly held characteristics of the Millennial generation that currently makes up the majority of medical students and residents in comparison with Gen Z learners. Millennials came of age during the relatively prosperous and peaceful 1990s, leading to an optimistic (and sometimes altruistic) outlook on the world around them. Their childhoods were more structured and scheduled than any previous generation and they had a great deal of influence on their family environment, the result of which is less comfort with ambiguity and a preference for informal communication with teachers and leaders. Their Baby Boomer parents tended to practice “helicopter” parenting, always being present for crisis management or to aid in logistical matters, translating into a need for more ready access to support systems than their predecessors [2]. During their youth, two messages were prevalent in their homes, schools, clubs, and popular media: “You can be anything you want to be” and “Participation in the team is the most important thing.” [3, 4]. These messages have led Millennials to have higher self-esteem compared with other generations and an affinity for group work [3].

Gen Z children were products of the post-9/11 world, a time of economic lability, political polarization, and multiple foreign wars. The media they consumed was more focused on negativity, with almost every Gen Z child seeing a popular figure they idolized suffer failures or scandals in full public view. However, they were also witness to advances in equality such as the realities of an African American president and strides related to gay marriage [1]. Their Generation Z parents often have had a “CIA” parenting style, using technology to be involved in their children’s lives and academic progress with less visible presence in day-to-day matters. Gen Z’s parents also tended to espouse their own preferences related to independence, identifying and coping with shortcomings, and skepticism with established processes and trends. These factors have led Gen-Zers to have a more pragmatic view of the world than Millennials, manifested as a higher prevalence of risk aversion, financial frugality, and an expectation that they will need to work harder than the generation that preceded them [3, 5].

Technology has played a pivotal role in shaping Gen Z’s preferences. At least 75% own smart devices and access them multiple times per hour [6]. Most spend at least 9 h interacting digital content daily [5]. Online videos are the preferred information source, with 95% watching YouTube every day. A typical Gen Z individual views approximately 70 videos on average daily, and at least two-thirds go to online videos for everyday instructional information [7]. However, Gen Z does not just consume material. More than half regularly create their own online content with a substantial number posting videos on social media platforms at least weekly [5, 7]. Electronic gaming is also important to Gen Z; it is estimated that many spend more than an hour each day playing video games [7]. Like their Millennial predecessors, Gen Z prefers electronic methods of communication with texting, mobile messaging apps, and social media being used most often [5, 7].

Experience with technology and in the online world has affected Gen Z’s preferences. Gen Z students expect on-demand, low barrier access to all information [7, 8], often selecting sources that package information in “bite-sized” pieces [9, 10]. Having grown up in the era of user reviews, they expect the ability to provide and receive real-time feedback, as well as having access to that provided by their peers [3, 7]. They also place priority on personalization and relationships, including institutions and authority figures [3].

Secondary and undergraduate teachers have noted other differences between Millennial and Gen Z learners. Gen Z students seem to have a greater tendency for “DIY” (task-oriented) and multichannel information gathering [11]. In the era of pushed information and “hyperlinks,” some have noted a reduced ability to form conceptual connections and greater difficulty distinguishing fact from opinion online [12]. Gen Z has also been shown to have a higher tendency to task-switch, shifting rapidly from one activity, task, or information source to another [13].

These lessons can inform pedagogical strategies to connect with Gen Z medical students. When developing curricula, skills to stress will likely include linkage of concepts, framing of questions, vetting of online content, and etiquette related to both providing and receiving feedback. Asynchronous content may be best received if it is video-based and personalized [7, 8, 14, 15]. Instructor-developed resources may not be the primary ones used by students [7]. As such, it will be critical for educators to be knowledgeable in the external sources Gen Z students are using, aid them in selecting those of high quality, curate recommended ones, and (perhaps) incorporate them into their lessons or learning plans [1]. Frequent use of reflection activities may be popular with Gen Z learners, playing into their social media experience [16]. Finally, real-time feedback on progress, perhaps using tools such as dashboards, will be of importance to Gen Z medical students [3, 5, 15].

Despite the generation’s technophilia, classroom interactions, and relationships with their instructors, both within and outside school, are rated as the most critical aspects of their learning [7, 14, 16]. These students value the personal experiences and discussions of practical applicability that the instructor-student dynamic enables. Of note, these interactions do not necessarily need to occur physically; virtual/online interactions and those occurring via social media or text messaging are of equivalent value to face-to-face meetings [3, 8].

In summary, while many of the trends noted among current Millennial medical students will continue among Gen Z learners, there are differences in the perspectives, preferences, and expectations of Gen Z students that may impact how they approach their professional training. Knowledge of these differences will help instructors better connect with the next generation of students and continue to develop effective, student-centered educational programs.


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Correspondence to Geoffrey A. Talmon.

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Talmon, G.A. Generation Z: What’s Next?. Med.Sci.Educ. 29, 9–11 (2019).

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