In a recent blog post, I described a cultural shift involving the use of smartphones at Jacobi Medical Center, a large, acute-care hospital that’s part of New York City’s public hospital system. When research from an Einstein-Jacobi study demonstrated that smartphone use during inpatient attending rounds can lead to distraction, our hospital instituted a “smartphone policy” in the departments of medicine and pediatrics during such rounds. The policy established clear guidelines for when smartphones can be used. It aims to maximize the many benefits these phones have for patient care, while safeguarding patient safety and promoting professionalism on the wards.

The policy has been in place since February 2012 and word is getting out beyond our walls. The most common question we are asked by our colleagues at other hospitals is, “How are your residents dealing with this?” Faculty members from institutions where smartphone use is both rampant and unregulated describe the frustration of vying with the devices for their trainees’ attention. They’d love to implement similar codes of smartphone conduct in their hospitals, they’ve told us, but doubt such a policy could actually work.

Their incredulity makes sense.

The millennial paradox

Born after 1982, the bulk of today’s residents and medical students hail from the millennial generation. Millennials have grown up with the Internet, and they use the technology intuitively. According to a Pew Research Center report on this generation, millennials’ defining characteristic — what they believe distinguishes them most from prior generations — is their use of technology.

Given that residents are digital natives whose learning and lives have been shaped by technology, it’s difficult to believe they would accept regulations placed on smartphone use in the hospital. But anecdotally, we’ve found that our residents seem to have accepted the smartphone guidelines. (Admittedly, some did initially find it humorous to have to announce to the team, “I’m going to use my phone to look up an article — is that okay?”)

So why were we finding acceptance of the policy even among millennials? In order to find out, my colleagues Yocheved Lindenbaum (at the time a Jacobi pediatrics resident) and Robert Sidlow and I decided to check in with our millennial residents to see what they thought about the rollout of the smartphone policy.

In November 2012, we surveyed all the residents in the departments of medicine and pediatrics to assess their attitudes. Amazingly, 82% of respondents “agreed” or “strongly agreed” with the statement, “It is a good idea to have clear guidelines and expectations about how team members should use smartphones during attending rounds.” Nearly 60% agreed with the specifics of the current policy; another 18% believed that while a policy is needed, the existing one should be modified. The only suggestion for modification we received was actually to expand the policy to include resident work rounds. The results were published in the Journal of Hospital Medicine.

Millennials seek clear work guidelines

Back to those millennials. Perhaps it was not so surprising to find the high level of agreement with the notion of clear guidelines. As with our study, prior research has found that millennials value explicit rules and expectations in the workplace. What was novel to us is that millennials appreciate and welcome rules that regulate their use of technology, even though it seems wired into them.

We recommend that other institutions try this as well, and not fear upsetting their house staff. The only caveat is that attendings must take the lead and serve as role models, taking care to use their phones in accordance with their individual hospitals’ policies in the clinical setting. We cannot expect our residents and students to appreciate or adhere to rules we do not ourselves follow.

A final lesson from the Einstein-Jacobi experience: The millennials are on to something important, and we should be listening closely. Their generation is telling us that the clearer our expectations, the better their experiences. As educators, we would do well to provide the clarity and ongoing support that may have been missing from some of our own educational experiences, when it sometimes felt as though our teachers thought we should “just know” what was expected of us.

Rachel J. Katz is assistant dean Albert Einstein College of Medicine, Bronx, NY. She blogs at The Doctor’s Tablet.

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