By: Eric Warm MD, MACP
“The only constant in life is change.” — Heraclitus
“Every generation imagines itself to be more intelligent than the one that went before it, and wiser than the one that comes after it.” — George Orwell
Have you ever caught yourself about to say to a learner, “Back in my day…”—then stopped just short, as if you’d almost uttered a curse word? Or maybe you’ve heard someone else say it, and it hit your ears like a dusty old cassette tape that somehow still plays. There’s a moment—equal parts nostalgic and cringe (am I allowed to use this word?)—when you realize you’re stepping into the very role you once rebelled against. The phrase can sneak up on us in the middle of a hallway chat, a feedback session, or a faculty meeting. It comes wrapped in concern, pride, or frustration—but rarely lands how we think it will. Let’s be honest: it’s not just a phrase, it’s a tell. It tells on our uncertainty, our grappling with change, and that quiet fear that maybe the way we were trained isn’t the way forward. And still… we feel the tug. So let’s dive in.
Historical Examples of the “Back in My Day” Folly
Throughout educational history, experienced educators have frequently defended traditions later recognized as misguided or even harmful:
- Sleep Deprivation in Residency Training: Long regarded as a badge of resilience; now clearly understood as dangerous, both to trainees and patients.
- Rounds as Intimidation Theater: Once viewed as a rite of passage to be grilled on obscure facts at the bedside; now recognized as more performative than productive, often promoting fear over learning.
- Technology Resistance: Initial resistance to using calculators, computers, and later, electronic health records—all once seen as threats to rigor and reliability; now embraced as essential tools.
- One-Size-Fits-All Learning: Rigid, linear curricula with little room for individual pacing or learning differences were once seen as necessary for standardization—now understood to limit engagement and fail to meet diverse learner needs.
Personal Reflection: Becoming Those We Resisted
Most of us currently leading educational programs vividly recall resisting or dismissing elders who proclaimed, “Back in my day…” We bristled at the implication that past methods were inherently superior or that our desire for innovation was a sign of weakness. Yet now, as we become those elders, we find ourselves tempted by the same nostalgic, often reactionary thinking we once despised. The transition is subtle yet profound, challenging us to confront our biases and fears about losing touch with emerging norms.
Current Medical Education Issues Prompting the “Back in My Day” Response:
- Wellness Initiatives: Increasing emphasis on mental health support and moral injury training.
- Sick Leave and Personal Days: More frequent and encouraged use of time off for health and personal care.
- Use of AI and Decision-Support Tools: Growing reliance on technology for diagnostic and treatment decision-making.
- Virtual Learning: Preference and sometimes expectation of remote or hybrid learning environments.
- Feedback and Grading: Shift towards narrative and formative feedback instead of numeric or comparative grading.
- Authority and Hierarchy: Increasing challenge to traditional authority and hierarchical structures in clinical training.
Why We Fall into the Trap: Navigating Paradoxes
It’s inherently challenging to avoid the “back in my day” mindset because it reflects deeper existential paradoxes in education and human behavior:
- Stability vs. Instability: We crave stability through tradition, yet innovation necessitates instability and discomfort.
- Order vs. Disorder: Effective education requires order and structure, but real learning often emerges from moments of disruption.
- Competition vs. Cooperation: Medical culture historically prizes competition, yet teamwork and cooperation now drive modern healthcare effectiveness.
Knowing When to Hold on and When to Let Go
One of the hardest things about being an educator in a time of change is figuring out where the line is between what we should hold onto and what we should release. It’s murky territory. Some traditions feel like anchors—foundational, stabilizing, maybe even sacred. Others? They’re more like sandbags weighing us down. The problem is, both can look and feel the same in the moment. What makes this so difficult is that we weren’t trained to differentiate between those two in real time. We tend to use our own experiences as a compass, but what happens when the magnetic field of culture and expectations shifts beneath our feet? We fear letting go of something essential, and we fear holding on to something harmful.
To visualize this tension, imagine a two-by-two square:
| Changing | Not Changing | |
| Being Right | Educator: Wise evolution. Learner benefits from modernized guidance. Learner: Gains a more relevant, thoughtful education.➡️ Win-win. | Educator: Holds integrity, maintains standards. Learner: Gains from timeless principles.➡️ Possibly wise, if context supports it. |
| Being Wrong | Educator: Adapts too fast, abandons valuable practices. Learner: May suffer from lost rigor or stability.➡️ Risk of superficiality. | Educator: Clings to outdated ways, risks irrelevance. Learner: May disengage or be harmed by obsolete methods.➡️ Lose-lose. |
So how do we know which square we’re standing in? Often, we don’t—until much later. But staying open, reflective, and willing to be wrong gives us a better shot at standing somewhere useful.
Equilibrium without Homeostasis
Humans and systems continually fluctuate between equilibrium and disequilibrium, but we rarely achieve lasting homeostasis—a perfectly balanced state (it’s why I can’t say ‘cringe’ and get away with it). Medical education, like biological organisms, adapts continuously to changing conditions. Clinging too tightly to past methods, simply because they once worked for us, denies the inevitability of this continual adaptation.
How We Can Respond as Educators
Educators must consciously resist falling into the nostalgic “back in my day” trap by:
- Practicing Reflective Humility: Regularly question our assumptions, openly acknowledging our biases.
- Fostering Genuine Curiosity: Rather than reflexively rejecting new ideas, engage earnestly with younger learners to understand their experiences and perspectives.
- Prioritizing Principles Over Practices: Emphasize core values—such as patient care, competence, and compassion—over rigid adherence to methods.
- Encouraging Open Dialogue: Create environments where learners can safely express dissent or suggest innovations without fear of dismissal.
- Maintaining Adaptability: View evolution in education not as a threat but as an opportunity to refine and enhance our teaching strategies.
- Committing to Lifelong Learning: Continuously seek new knowledge, methods, and insights, modeling the adaptability we wish to foster in our trainees.
By embracing these strategies, educators can navigate educational change thoughtfully and compassionately, ensuring that our training programs evolve effectively to meet future challenges without losing sight of timeless educational values.
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