Training and Integrating Millennial Workers into Your O&P Practice

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generational table

The arrival of the Millennial Generation on the employment landscape means that a more diverse multigenerational workforce is becoming the norm for most professions. This change in the workforce offers challenges and opportunities for O&P employers and residency directors as this generation is said to have distinctly different behaviors, values, and attitudes from previous generations. The first occasion for many employers to face these opportunities may come when considering candidates for a formal residency or when hiring a younger practitioner in the first few years following that practitioner’s certification. This article will explore strategies that employers can adopt to help navigate intergenerational dynamics and build mutually satisfying, long-term relationships with members of the Millennial Generation.

The current business environment contains four generations of workers. With veteran employees transitioning to retirement or having retired and baby boomers joining them at an accelerated pace, Generation X would logically be expected to fill the resulting gap in knowledge and experience.1 However, the 45 million members of Generation X cannot possibly fill the need for experienced workers caused by the 75 million baby boomers exiting the workforce. Increasingly, the gap will be filled by those in the Millennial Generation.

The future supply of O&P professionals is not expected to meet the demands of the U.S. market.2 Employment of O&P professionals is projected to grow 36 percent from 2012 to 2022, much faster than the average for all other occupations. This rapid growth will result in an estimated 3,000 new jobs during this 20-year span.2 Adding millennial graduates to the O&P labor force represents a way to lessen the impact on the profession of reductions in the labor force due to retirement, and minimizes the compromises to quality patient care that could result from a shortage of qualified practitioners.3

Because of an increased demand for O&P-program graduates, job-seeking practitioners will be able to choose between multiple facilities when considering employment options, requiring that employers actively compete for these healthcare professionals. Employers will be more successful in filling vacant practitioner positions if they can effectively manage residents and practitioners from the Millennial Generation. The ability to attract and retain millennial employees will become an increasingly important business development strategy.


A primary concern for business leaders is whether the Millennial Generation is adequately prepared to fully participate in the workforce. Twenty million inexperienced workers entered the workforce between 2006 and 2010 with an expected four million to be added annually through 2023.4 In addition to the influx of inexperienced workers, more than 40 percent of the U.S. workforce was eligible for retirement in 2010.5 The combination of the loss of knowledge and experience due to retirement, and the replacement of experienced workers by younger, less-experienced colleagues is causing a workforce readiness crisis.6

Many business leaders question whether institutions of higher education are able to deliver college graduates who are prepared to meet employers’ expectations.7 Business leaders frequently express concern that millennial workers lack basic skills upon entering the workplace as well as lack the breadth of knowledge and experience possessed by their predecessors. Basic soft skills, those skills not exclusively related to O&P that enable someone to work effectively with others, dominate workplace needs.

In a 2006 survey, a majority of employers were dissatisfied with new millennial employees’ generic skills such as teamwork, problem solving, and attitudes about work.7 In a 2007 survey, 86 percent of the employers surveyed expressed dissatisfaction with new millennial employees’ ability to express themselves verbally or in writing.8 Human resource professionals indicate millennial workers are not prepared for the realities of the workplace and cite lack of competency in areas such as soft skills, organization, and business acumen.9 In addition, a national survey by the American Institutes for Research, results of which were released in February 2006, found millennials to be deficient in basic quantitative skills.10


The experiences of the Millennial Generation are different from their parents, and different approaches to training and development may be required in order to hire, train, motivate, and retain this valuable resource.11 The need to train millennial workers to progress more rapidly as replacements for the increasing number of retirees each year is a business imperative. Business leaders need to understand the impact of the transitioning workforce, and training and development methods must improve in order to prepare millennial workers for the challenges of the business environment.

Brown suggested the failure to train and engage the Millennial Generation will lead to higher costs resulting from lower productivity, reduced employee commitment, and increased attrition.12 It is the responsibility of the current employers to understand the Millennial Generation and to modify policies within their organization to accommodate generational shifts in the workforce. It is apparent that business managers and trainers will need to understand more about the preferences, attitudes, and characteristics of millennials to remain competitive in the upcoming decades.13


Generational boundaries are not always completely clear, and various authors use different time spans to identify the Millennial Generation. Most sources agree that the Millennial Generation (sometimes referred to as Generation Y, GenY, GenMe, Generation Next, or the Boomerang Generation) is composed of individuals born between the early 1980s and early 2000s. The first members of this cohort turned 18 around the year 2000.14 Students currently completing a master’s degree in O&P immediately following their undergraduate work will fall into this cohort. Residency directors can expect that a number of the applicants for their open positions will be millennials.

While there is no shortage of information published in the popular press identifying traits of the millennials, some researchers have expressed concerns about the amount and quality of actual research related to this generation. Twenge et al. say that “empirical evidence for generational differences in work values is scant. Much of the current literature employs nonempirical sources such as anecdotal accounts or extrapolations based on different generations’ life experience…. This literature relies on qualitative interviews…[and] there is less empirical evidence about GenMe than about any other generation.”15

However, quantitative and qualitative research demonstrates that each generation has unique characteristics shaped by its place in history as well as its cohort size.16 Identifying common themes in the qualitative reports of members of various generational cohorts can provide valuable insight into how an intergenerational workforce and the individual generational cohorts can be managed effectively. The remainder of this article will provide perspective on several areas that are key to successful intergenerational training.


The impact of technology on the Millennial Generation is readily apparent. Millennials reaching adulthood in a world that includes almost ubiquitous Internet access and cellphone usage (digital natives) have a very different relationship to that technology than individuals who have adopted it later in life (digital immigrants). Managers who are part of the baby boom or Generation X should be aware that technology that they consider supplemental or ancillary is often considered vital to normal function in business and personal life by millennials.

A good example of this technological divide in O&P is this anonymous response to a question posted recently on the OANDP-L listserv about the availability of residency positions: “My concern with current applicants is that they are using 21st century tools to look for jobs that are really closer to mid- 20th century in attitude. This profession is too small and close to rely entirely on e-mail.”

This post identifies a potential disconnect between residency directors and residency candidates with differing communication technology preferences. Just as students seeking residencies must be aware of how potential employers prefer to communicate, employers hoping to hire and retain the most competitive graduates must understand and adopt communications technology that is widely used by these candidates.

Technology is only one factor in education. Traditional and contemporary methods of instruction should be used appropriately as dictated by the needs and preferences of the unique individuals involved in a residency. On an encouraging note, DiLullo et al.17 reported that analysis of research data suggests that [millennials] may not be as different from other generations in the fundamental process of learning as is regularly proposed. In addition, DiLullo et al. found the number of pages read per day in school and for homework by millennial students had actually increased.17 Methods such as one-on-one instruction, in-person demonstration, and reading continue to be very important and can be readily adopted by members of any generation. As one author notes, “Good teaching is not replaced by technology, but rather enhanced by it.”14


Factual information on almost any topic is readily available and easily accessible to anyone with a reliable Internet connection. After confirming the reliability of the source, obtaining answers to content-based questions is not particularly challenging. Perhaps related to this ease of access to information, DiLullo et al. found that millennials appear to lack the skill to critically analyze information and determine what is and is not valid.17

Residency training is the intended venue for learning how to apply academic knowledge to real-life scenarios. Employers and other mentors should focus on the development of critical thinking strategies, allowing the residents and less-experienced clinicians to develop an understanding of how to address clinical challenges rather than simply providing answers. “Providing the novice with predetermined schemas for problem solving may limit their ability to independently synthesize appropriate knowledge and experience for the development of their own expert critical thinking.”17 Providing the “right” answer is less important than guiding residents and junior clinicians in the clinical decision-making process.

Emphasizing tradition or insisting on “the way we’ve always done things” may hinder the development of critical thinking skills in the next generation. Roberts et al. advise that teachers can provide key support by emphasizing relevance and helping learners prioritize and identify context for their education.14

Additionally, experienced O&P clinicians can and should regularly provide insight and perspective that helps residents develop the soft skills practitioners require. Roberts et al. point out that, “[i]n contrast to a web-based service that provides solely factual answers or content, you as a ‘live’ teacher have the opportunity to interact and connect with learners through shared experiences and opportunities to model how to prioritize learning tasks, apply information to solve problems, and balance work interests and family life.”14


Many of the cited authors agree that the members of the Millennial Generation have high expectations regarding feedback. Effective feedback requires that behavior is directly observed by the person delivering the feedback, it is given by an authoritative source, and it occurs over an extended period of time.18 A formal residency provides an effective structure for meeting these conditions. Residency mentors should not assume that junior O&P clinicians possess the required knowledge and skills to work independently without confirming this through observation. Initially, most tasks performed by a resident should be observed directly by a supervising clinician. Workload pressures and the expectations of productivity should remain secondary concerns early in the residency and training process. Regularly scheduled observation of clinical tasks provides the basis for ongoing feedback as the resident’s experience and confidence level increase.

O&P residency directors and other mentors should offer feedback “on decisions and actions rather than on intentions or interpretations” with the focus “on what was done, rather than what was presumed to be thought.”18 Experienced clinicians may be tempted to criticize a novice clinician’s intentions or motives, particularly after observing a significant mistake or oversight. Anderson suggests asking learners for their own observations of the particular performance, followed by supportive comments by the teacher and some probing of how the learner might do it differently in the future, and ending with a mutually agreed upon plan for improvement.18 Roberts et al. observe that “[f]requent comparisons to ‘the way I was taught’ or prior educational experiences may prevent a focus on the current generation and its own unique learning needs and special capabilities, which tends to put the students on the defensive.”14

While millennials may be more open to feedback than previous generations, they are not unique in this expectation. Meister reports that in a survey asking “respondents to rate the importance of eight different managerial skills, respondents in all generations placed a high premium on having a manager who ‘will give straight feedback.’”19 An awareness of other generational differences should not discourage a manager or mentor from providing the feedback the younger clinician considers a valuable part of the relationship.


While awareness of generational differences can be beneficial for all parties, more focus should be placed on the unique qualifications and needs of the individual resident and clinician. The authors of a 2010 study (one of the few studies comparing people of the same age at different points in time) made the following conclusions based on their research: “There are much greater differences in job performance within age groups than between age groups, and the same is true of the generations: There are average differences but still plenty of variation within each generation….”

Many perceived differences between generations may be more related to age, maturity, life experience, and individual personalities. Roberts et al. fittingly advise employers to “[h]ighlight areas of overlap and similarity, rather than difference, between prior and current learners.”14

John Brinkmann, MA, CPO, LPO, FAAOP, is the lead prosthetic instructor at the Northwestern University Prosthetics-Orthotics Center, Chicago, Illinois. He has more than 20 years of experience treating a wide variety of patients and is chair of the American Academy of Orthotists and Prosthetists Gait Society.

Robert Huddler, PT, DPT, BOCP, is currently the president of Advantage Prosthetics and Orthotics, Pikesville, Maryland. He has more than 20 years of experience in healthcare and is a member of the American Academy of Orthotists and Prosthetists and the Lower Limb Society research chair.


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  2. U.S. Department of Labor, Bureau of Labor Statistics. 2013. Economic News Release, Table 6: Employment by major occupational group, 2012 and projected 2022.
  3. American Academy of Orthotists and Prosthetists Research Department. 2013. Prosthetist member demographic profile 1999-2013. Alexandria, VA: American Academy of Orthotists and Prosthetists. Retrieved from
  4. U.S. Census Bureau. 2000. Census of population, general population characteristics (CP-1-1). Retrieved from
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  10. American Institutes for Research. Press release: January 19, 2006. New study of the Liberacy of College Students Finds Some Are Graduating with Only Basic Skills.
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  13. McFerran, J. 2008. To Attract Gen Y Workers, Think Like Them. People First HR Services. Retrieved from Original source: Winnipeg Free Press, August 9, 2008.
  14. Roberts. D. H., L. R. Newman, and R. M. Schwartzstein. 2012. Twelve tips for facilitating Millennials' learning. Medical Teacher 34 (4):274-8.
  15. Twenge, J. M., S. M. Campbell, B. J. Hoffman, and C. E. Lance. 2010. Generational differences in work values: Leisure and extrinsic values increasing, social and intrinsic values decreasing. Journal of Management 36 (5):1117-42.
  16. Howe, N. and H. Strauss. 2000. Millennials Rising: The Next Great Generation. New York: Vintage Books.
  17. DiLullo, C., P. McGee, and R. M. Kriebel. 2011. Demystifying the Millennial student: A reassessment in measures of character and engagement in professional education. Anatomical Sciences Education 4 (4):214-26.
  18. Anderson, P. A. 2012. Giving feedback on clinical skills: Are we starving our young? Journal of Graduate Medical Education 4 (2):154-8.
  19. Meister, J. C., and K. Willyerd. 2010. Mentoring millennials. Harvard Business Review 88 (5):68-72.
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