What’s Medical Education Missing

Gen Z – a generation of holists?

Editorial by Professor David Peters
JHH 20.1 Holism and Medical Education

As genes and upbringing are shaping our personalities, each generation grows up surfing the waves of a changing culture. The theory goes that this puts a unique stamp on the mindset and preferences, expectations and worldviews of a whole generation. If this is so, then as the pace of social change speeds up, inter-generational differences will get wider.

Most medical and nursing students and young practitioners are in their teens and 20s, generation Zers born after 1995. Their generation X and generation Y parents are now middle aged, and their Baby Boomer grandparents would have arrived in the aftershock of World War Two.

How far the culture’s tectonic plates have parted since those post-war years when the NHS was new! Yet even since the mid-1990s so much has changed: the infant internet had only 16 million users (there are nearly 6 billion now), the USSR was imploding, apartheid had just collapsed, and atmospheric CO2 had hit a critical 350 ppm. In the late 90s globalisation’s boom years got underway, CO2 kept climbing and seismic shifts began to re-define what it is to be human – an exponential growth of IT, the pan-global information swarm, genetic engineering, inexorable climate change.

History and theology are awash with imaginary apocalypses, but the end of times came up-close and personal in the 1950s. Baby boomers had the bomb, gens X and Y HIV-AIDS, gen Z the sixth mass extinction. Whether these dark elements in the zeitgeist preoccupy us or not, the prospects of climate breakdown, terrorism, social collapse and further pandemics run in the background, although like the ticking of a clock we tune them out. Optimists such as your editor expect crisis and opportunity to walk hand in hand, and for human creativity to find ways of making peace between people and with the planet. But just how rocky a road we will travel to get there depends absolutely on what we do now. Medicine, with its own crises of cost, care and commitment, could simply fall in with business as usual, patching up the casualties of a society arguably in decline. Or it could expand its horizon and play a major part in reducing the harm.

Gen Z will shape the future. What can they tell us? Can we take their pulse, heed their experience, read the writing on their wall? Surveys and sociologists (assuming they can justify these generalisations) tell us this generation respects diversity of race, gender, sexual orientation or religion; that they are the first ‘digital natives’, the tech boom having immersed them lifelong in free information and entertainment. Yet despite these riches gen Zers report the least positive life outlook, including lower levels of emotional and social well-being than older generations (www.mckinsey.com/industries/ healthcare/our-insights/addressing-the-unprecedented- behavioral-health-challenges-facing-generation-z).

Why so? Is it down to unlimited screen time, late night online gaming, missing out on real social contact while engulfed in social media ‘s compare-despair mindset? All might play a part, but the real challenge is surely how to sustain emotional wellbeing in an ever more VUCA (volatile, uncertain, complex and ambiguous) world. Those with the courage to face the VUCA tempest have very good reasons to feel alarmed. Activism is a better way of coping than denial and dissociation. If, as the pundits tell us, gen Zers are more likely than older generations to be activists, and more conscientious, more engaged and politically progressive, their commitment to social and climate justice will be good for them as individuals, but also for society and the Earth. The future of health- care will be in good hands if, as our own student survey suggests, many gen Z are would-be holists.

JHH authors are holists and activists with a lot to say about what it takes to flourish while juggling the arts and science of medicine and nursing. The winter 2022 journal probed into what medical education is missing, and in response this issue seeks out inspiring examples of new ways to learn about joined-up healthcare. We look back a little to be reminded that medicine was not always industrialised, that it can still be – should always strive to be – relational and humane. Then we explore ahead with articles from path-finders in education preparing the way for future versions of holistic biopsychosocial healthcare. They may be teaching about the bodymind, or teaching medicine in the community, learning leadership in the wilderness, or the relevance to medicine of Buddhist wisdom, and the powerful role of creative arts. Ever keen to hear students’ experience, we include reflections on nutrition, on learning from experience about homelessness, bullying, and the need for selfcare. Articles from leaders of Balint Groups and Schwartz Rounds pursue this journal’s ongoing concern for emotional intelligence in medicine. To round off the issue, a new column from inner city GP Jonathan Tomlinson asks what happens to empathy in medical education.