Of all the transitions after starting the multitiered training process in medicine, the fellow to attending evolution has to be one of the most daunting. The onus of responsibility that occurs after graduating fellowship is several orders of magnitude more challenging than even the medical student to intern transition. It seems that almost overnight a graduating fellow permanently loses the comfort of the very protective training umbrella and assumes the role of being in-charge. This change can feel even more weighted when practicing in a procedural field. The trainee suddenly assumes not only the sole responsibility of the patient on the table but also is supposed to know how to guide the nervous hands of a first-year cardiology fellow – hands that are very likely to be those of a millennial in 2019.

Though generational cutoffs are an inexact science, generations are defined by key political, economic and social events. For example, the Pew Research Center defines the millennial generation as those born between 1981 to 1996, followed by the post-millennial generation (1997-present). Most millennials are old enough to remember and understand the lasting geopolitical impact of Sept. 11, 2001, they were the powerful voice of the youth that helped elect Barack Obama as president, and they have grown up in the midst of an economic recession. They require and need constant connectivity, and social media is their sixth sense without which life would be less lived. These among many other factors have shaped the ethos and emotional IQ of the millennial generation, which are noticeably different from previous generations. Better knowing and understanding millennials and their expectations can be a very valuable lesson for those in their early career, as they may find themselves working with or mentoring millennials.

This becomes even more important when we realize that the training culture in medicine is deeply woven around ideas of hierarchy, tradition and assumed respect based on rank. These concepts are in many ways "anti-millennial," who have been called "Trophy Kids" and referred to as "Generation Me." Though generalizations are not completely accurate, there are consistent trends which suggest that millennials are self-centered and in some ways more narcissistic than previous generations. They thrive on positive reinforcement and are less likely to accept negative criticism. This can affect how they learn and what they expect as trainees, almost mandating that mentoring skills be adjusted accordingly.

Listening to senior faculty (baby boomers) tell stories of days in the cathlab when attending physicians reigned supreme and any misstep by a trainee could result in ejection from the cathlab, or at the very least a hand slapping, seems juxtaposed from what millennials can and do expect from their training experience in 2019. As a Gen X interventional cardiologist, trained by early Gen Xers who were trained by baby boomers, my cathlab experience lies closer to what senior faculty describe. By no means did I have a hostile training experience, and in some ways, we have been described as having it easy when compared to my mentors. However, as a trainee, I needed to be prepared for whatever was and would be required of me by each of my mentors. I expected myself to make the most of training regardless of the fact that it was hard and challenging at times. It was inconceivable for me to think about complaining or anonymously "writing' up" my attending over a difference in expectations.

As I transition through my years as faculty (now close to entering mid-career), I find myself struggling with the following: How do I meet the expectations of a generation different from mine and bridge the proverbial generational gap? How do I best teach, train and mentor them without lowering my expectations? How do I let them know what is expected without causing them to disengage?

A recent article in the Journal of the American Medical Association discussed myths, truths and best practices to help with mentoring millennials. Traits such as impatience, entitlement, laziness, narcissism and neediness – which have been used to describe millennials – in reality may represent efficiency, motivation, balanced, empowerment and engagement. As an example, "millennials generally desire frequent interaction, are quick to multitask and relish the ability to connect rapidly across the globe. These connections are often brief and need not occur within a backdrop of lengthy face-to-face connections. As a result, millennials differ in skills critical to building professional relationships and may be perceived as impatient and needy, rather than efficient and engaged." Understanding this shift in perspective may allow us to shift our own perspective about the generation.

It may be time to make a concerted effort towards developing a better understanding of the "millennial approach," especially since they are about to represent more than half of the work force. Applying the same hard-nosed expectations to Gen Me is not only ineffective but also may be disadvantageous to an entire generation of physicians and the medicine they practice.

This article was authored by Bina Ahmed, MD, FACC, assistant professor of medicine at the Geisel School of Medicine and interventional cardiologist at Dartmouth-Hitchcock Medical Center in Lebanon, NH.