Generation Me or generation me?

Abstract

Many educators believe that students today differ from those in the past, and often ruminate about the good old days when they were students. Recognition that generational differences exist is important to improve the educational experience, success, and value for money of today's students—so-called Generation Me (a term coined by the psychologist Jean Twenge). Such students allegedly prefer multimedia content, demand greater flexibility, and have little desire to read long texts. Imbued with self-belief and entitlement, they place a stronger emphasis on work–life balance than did previous generations, such as mine (termed generation me). Generation Me students prefer doing things (usually via multitasking) to sitting down and reading. The downside of this attitude, of course, is that textbooks might never be read, or merely skimmed at best. Textbook publishers and course organisers are increasingly aware of the Generation Me effect, which has led to the development of shorter textbooks and easy-to-digest course notes. It is not only students but also modern courses that differ from those of previous generations. Content, style, delivery, and assessments have all changed substantially. Medical education has been integrated into systems-based modules, whereas traditionally teaching was separated into basic science and clinical components. Modern medicine has also changed massively. Endocrinology and metabolism, like other specialties, has been revolutionised by advances in molecular biology (especially genomics, transcriptomics, proteomics, and metabolomics), clinical chemistry, imaging, and treatment, which include developments in both existing (ie, drugs, surgery, radiotherapy, and biotherapy) and investigational (eg, gene therapy, nanotechnology, and regenerative medicine) treatment modalities. Additionally, the specialty of endocrinology and metabolism is no longer at the fringes of medicine, and now includes some of the most common and serious public health challenges facing both high-income and low-income countries. For example, according to worldwide estimates, 1·7 billion people are either overweight or obese, and more than 500 million people have either prediabetes or type 2 diabetes mellitus. The associated human, financial, and societal costs incurred by people with these disorders are sobering. Other prevalent endocrine and metabolic disorders include postmenopausal syndrome, thyroid disorders, metabolic bone diseases, and type 1 diabetes mellitus. Against this backdrop, Saffron Whitehead and John Miell have written a completely new textbook called Clinical Endocrinology. The scope of the book is ambitious and the intended readership quite broad, ranging from undergraduates to trainees in subspecialties of endocrinology. Clinical Endocrinology is very well written and beautifully illustrated. Its content is very comprehensive and almost at the cutting edge of current knowledge. Case studies and self-assessment questions are embedded throughout and help the reader to understand the information presented. My major criticism is that diabetes (both type 1 and type 2), one of the most frequently encountered medical disorders irrespective of specialty, is not covered as comprehensively as are some of the less common disorders. Most undergraduate and postgraduate endocrinology and metabolism textbooks typically dedicate about a third of the book to discussion of diabetes and related complications. By contrast, about only a ninth of Clinical Endocrinology is related to diabetes, and some important information is not covered. For example, no pictures of diabetic retinopathy or diabetes-related foot issues are included. Furthermore, inpatient diabetes management was not mentioned at all, and diabetic nephropathy (the most common cause of end-stage kidney disease in western countries) was hardly discussed. Lipids and cardiovascular risk assessment are superficially covered in three pages, despite cardiovascular complications causing the deaths of more than two-thirds of diabetes patients, whereas eight pages of text and 14 colour histology illustrations are devoted to thyroid cancer. I am also concerned about the book's intended readership. Although its scope is laudable, Clinical Endocrinology is far too long and comprehensive for most undergraduates. On the basis of my experience teaching an endocrinology and metabolism module at a medical school, I believe that this textbook is way off the mark with respect to content, and is unlikely to ever be read. Generation Me are unfortunately more likely to use Wikipedia. An interactive, digital version is needed for the book to be successful with its intended audience. I anticipate that more advanced subspeciality trainees will find it useful for background reading and preparation for knowledge–based assessments or American Board Certification. Senior clinicians might also find the text useful, especially because programmes to assess knowledge and competency are becoming more commonplace. Despite these criticisms, Clinical Endocrinology deserves great success and wide readership. Hopefully, a shorter, more focused second edition with an accompanying digital version will be produced. Greater clarity about its intended audience—Generation Me or generation me?—is also needed.