Medicine and Schooling

I am fond of arguing that medicine and teaching have a lot in common.  Of course, they are both helping professions; at their best, they both rely on evidence; they have the capacity to change lives; and they do so within a social framework – all of us learn better from teachers we have relationships with, and medicine is surely the same.

There is no one more able that Atul Gawande to tease out the similarities.  (He has drawn the comparison explicitly in piece “Personal Best” in the New Yorker, which I’ve already written about.)  Gawande represents a helpful mental model of professional practice: he understands the tension between the importance of long-term research projects and the immediate goals of improving practice with existing knowledge; he emphasizes the need for diligence, persistence, and getting results; he thinks practitioners should also approach their work with a scientific mindset.  He is also alive to the human side of practice.  He is able to weave quantitative and qualitative evidence into a satisfying narrative of, in this case, how medicine can improve; but the corollaries to teaching are obvious to anyone.

The following quotations are from his 2007 book, Better.  While he intends none of these to even tangentially relate to schooling, anyone who has spent any time in schools will see the corollary.

I. On the Importance of Diligence

“Betterment is a perpetual labour.” (9)

II. The Data-Improvement Connection

“In medicine, we are used to confronting failure; all doctors have unforeseen deaths and complications.  What were not used to doing is comparing our records of success and failure with those of our peers.  I am a surgeon in a department that is, our members like to believe, one of the best in the country.  But the truth is that we have no reliable evidence about whether we’re as good as we think we are.  Baseball teams have win-loss records.  Businesses have quarterly earnings reports.  What about doctors?” (207)

III. High Expectations

“The paradox at the heart of medical care is that it works so well, and yet never well enough.  It routinely gives people years of health that they otherwise wouldn’t have had.  Death rates from heart disease have plummeted by almost two-thirds since the 1950s.  Risk of death from stroke has fallen more than 80 percent.  The cancer survival rate is not 70 percent.  But the advances have required drugs and machines and operations and, most of all, decisions that can easily damage people as save them.  It’s precisely because of our enormous success that people are bound to wonder what went wrong when we fail.” (105-6)

IV. On the Superior Value of Applying Current Knowledge vs New Research

“To be sure, we need innovations to expand our knowledge and therapies, whether for CF of childhood lymphoma or heart disease or any of the other countless ways in which the human body fails.  But we have not effectively used the abilities science has already given us.  And we have not made remotely adequate efforts to change that.  When we’ve made a science of performance, however – as we’ve seen with hand washing, wounded soldiers, child delivery – thousands of lives have been saved.” (233)

V. Applications for Schooling?

Imagine what we could do as a field if teachers adopted this mindset.  Imagine the coherent and purposeful improvements we could make if we, as a field, took on the set of dispositions and assumptions embedded in his words above.  Imagine how we could move from the fairly random collection of hot topics in education towards a “a science of performance.” (233)