Simulation: coaching Oscar performances from Millennial nursing students

October 2015 Vol 15 (5)

GWEN ERLAM set out in her doctoral research to bridge the generation gap and find the best way to reach and teach Millennial nursing students using simulated learning environments.

Gwen ErlamIt is now widely believed that generational tendencies can be tracked by birth cohort. 

Nurses currently working in the health sector span four generation cohorts (see box). The oldest cohort began training in the 1960s, the newest this millennium, so each generation has been prepared for professional practice in quite different ways.

Today’s data-rich infosphere has profoundly influenced the youngest generation in their attitudes toward family, career, risk, romance, politics and religion. Generational theorists argue that the generational tendencies indicate a clear break between those born from 1982 onwards and those born before. The newest generational persona, the Millennials, are said to be unique and to have seven distinguishing characteristics. They believe they are:

Special: Millennials have an inculcated sense that they are, collectively, vital to the nation and to their parents’ sense of purpose.

Sheltered: With the explosion of children’s safety rules and devices, Millennials are the focus of the most sweeping youth safety movement in history. From car seats to bike helmets and vaccinations to private tutoring, Millennials have been provided for and protected like no previous generation. 

Confident: Due to high levels of trust and optimism and a strong connection with parents and the future, millennial teens are often boastful of their generation’s power and potential.

Team-oriented: With the new emphasis on classroom learning, Millennials prefer group learning and working in teams. Relationships are characterised by tight peer bonds.

Achieving: With increased accountability and higher academic standards, Millennials are on track to become the best-educated and best-behaved adults in history.

Pressured: Millennials are pushed to study hard, avoid personal risks, and take full advantage of the collective opportunities adults are offering them. Receiving awards, trophies, medals and certificates since an early age has produced a ‘trophy mentality’ in this generation, which can be used to maximise their effort and engagement with learning. 

Conventional: In contrast with previous generational cohorts, Millennials take pride in their improved behaviour and are more comfortable with their parents’ values than any other generation in living memory. Millennials support convention – the idea that social rules can help.*

Speaking to millennial nursing students

When considering all these characteristics collectively, it occurred to me that we as educators might be preparing nursing students in a manner that fits with our own preparation, but does not ‘speak’ to millennial learners. The focus of my doctoral research, using action research methodology, was to design more effective platforms to ‘reach’ millennial students through simulated learning.

Simulation as a teaching and learning tool maximises many of the above identified tendencies in millennial learners, allowing them to construct their learning in ways uniquely personal and engaging.

Their team orientation makes simulation an effective teaching and learning platform when used in groups of three to four. Each group is viewed as a team and encouraged to communicate and build roles into their simulation performance in order to maximise collaboration with other team members. The ISBAR (Identity, Situation, Background, Assessment, and Recommendation) communication tool was used to communicate with other professionals encouraging interprofessional collaboration.

Due to Millennials’ focus on achievement, coupled with their potential risk aversion, I found it was important to design simulation opportunities that allow for a repeat performance after being given feedback. This means the millennial student is given an opportunity to perfect their performance in what I called their ‘Oscar performance’.

I often modelled the expected performance (performing all roles myself) in order to help these ‘performance-oriented’ students see what was expected. This modelling was a form of tutoring, and also a way of encouraging risk-averse Millennials to continue to improve in their management of deteriorating situations in real clinical environments. This modelling aspect of my simulation design was the most valued feature reported in a post-simulation questionnaire of 125 students. The students reported that this modelling made the goals clear, and enabled struggling students to improve without losing face.

As stated above, millennial students consider themselves ‘special’ and are accustomed to individual feedback. This was given in the debriefing section of the simulation. Students were able to take the feedback and perfect their performance. Debriefing feedback fuelled engagement and motivation to improve in both clinical reasoning and skill performance in the simulation.

In order to tie into the ‘trophy pursuits’ of many millennial students, I produced a certificate that was given to each student upon completion of their simulation experience. This ‘trophy’ was highly valued by these Millennials, who have earned trophies and certificates all their lives. They often emailed me if their certificate did not arrive within a few days of their simulation experience in order to ensure that I did not forget how well they did! This often made me smile as I realised I was designing the kind of classroom that they enjoyed engaging with. They pursued their ‘Oscar performance’ with a vengeance. It was a win-win for everyone involved.

In summary, I found that effective millennial classrooms embodied a different design from the classrooms many Baby Boomer and Gen Xrs were accustomed to. Due to collaborative tendencies, Millennials enjoy working in teams.

Due to privileged and protected upbringings, many Millennials are risk averse and prefer modelling and repeated attempts in order to ‘get it right’. When designed well, simulation has the ability to meet the needs of millennial learners in ways that traditional classrooms may not, thus paving the way for simulation to become the ‘preferred classroom’ for future Millennial healthcare students. :

*Howe N & Nadler R. (2008). Millennials rising. Leadership for Student Activities, 36(8), 17-21. Retrieved from

The author: Gwen Erlam BSN MA is a senior lecturer in nursing and a doctoral student at AUT.

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