Doctors and Their Relationships with Patients (Joel Merenstein)

Over the years I have written this blog, I have posted comparisons of medical clinicians and public school teachers. The substantial differences between the two helping professions (e.g., doctors work one-on-one, teachers in groups; doctors’ decisions can have immediate consequences for life and death, much less so for teachers; differences in salaries; social status, etc.) seemingly made comparisons far-fetched. What I focused on, however, was the centrality of the relationship between teacher and student, doctor and patient, as the core of both helping professions, one for learning in school and the other maintaining good health for patients (see here and here).

In this post and others to come, I offer examples of such a relationship between doctor and patient that captures the depth, breadth, and importance of that relationship  to both clinician and patient. Such accounts are uncommon in medical literature.

Joel Merenstein retired in 2005 from his family medicine practice in Pittsburgh (PA). He wrote this article for The Journal of Family Practice in 2010. He and two colleagues have recently published essays about family practice in The Human Side of Medicine.*

Being in practice for 42 years was like running a marathon. Things seem easy and pleasant at first, but then as time goes by, you hit the “wall” and you feel like you can’t go on. “It’s just too hard,” you think. And you wonder: “What am I doing here?”

In an actual marathon, you hit that wall somewhere around the 20-mile mark. (At least that’s what my son tells me.) But in my family medicine practice, I hit the wall at the 10-year mark.

If, like me, you decide not to quit, the endorphins kick in. You feel a high and know you could go on like this forever. You wonder to yourself: “Can life really be this good?”

And then, as the years pass by, you and your patients change and you know the race is coming to an end. It’s time to stop running. Yet, there are many losses in giving up practice. After spending nearly a lifetime as a doctor, it’s hard to give up that identity. That’s who you are, and who you have been.

In my case, I saw the doctor-patient relationship as a “covenant, not a contract,” as Gayle Stephens, MD, described it, and my role as a physician was to prescribe myself as my most potent therapy, as taught by Michael Balint.1

David Loxterkamp has written about “being there” as the prime service of the family doctor.2 But in retiring you are not there—at least not the way you once were.

How about lunch, doc?

When I retired 5 years ago, many patients wanted to “go out to lunch” or in some way maintain our relationship. I avoided this, saying that I thought it was important for them to develop a relationship with their new doctor. This was (and is) true, but I’ve come to realize that it is not the most important reason to pass on such invitations.

Lovers breaking up say they can “still be friends,” even though they know that is impossible. They can neither give up the special feelings they have had, nor the memories of those feelings that will always be a relevant part of their lives. Similarly, I have too much invested in these relationships to “just be friends.”

Moving on
I have moved on. My wife of 52 years and I travel and visit our children and grandchildren. I take and teach classes at a program for retired people. I have more free time than I have ever had, and I don’t miss the constant sense of responsibility for others, or the time spent agonizing over mistakes. But it was the right time to leave practice when technological advancements were accelerating at lightning speed, and my energy level was no longer keeping pace.

Mixed emotions when I talk to patients.

I must confess that I periodically call patients to see how they’re doing. It’s really more for me than for them—but I try not to make that obvious.

Despite not wanting to have lunch with my former patients, I must confess that I periodically call some of them to see how they are doing. I realize that it is really more for me than for them—but I try not to make that obvious. Our conversations leave me with such mixed emotions.

Feeling guilty
Bob and his family were patients of mine almost from the day I started. I attended their daughters’ weddings, shared in their tragedies, cared for multiple illnesses, and counseled the children. When Bob was diagnosed with Alzheimer’s disease, I told him it was very early and we would go through it together and learn from each other. Then I retired.

I know through my conversations with him and his family that he has gone on with good care. But he has gone on without me.

I feel guilty.

I realize that some of this is ego—a loss of importance. But mainly I feel badly that I am not fulfilling that promise I made to him. And I have “cheated” myself out of the pleasure of learning and giving.

Feeling incomplete
I was particularly close with Marylou and her family. I attended birthday parties, cared for her and her husband’s chronic illnesses, supported them through the illness and death of their daughter, and listened when that’s all I could do. Last year, Marylou called me when she was diagnosed with breast cancer. I stayed in touch and expressed my pleasure when she did well. But, I wasn’t involved in the therapy decisions and I wasn’t there when it was time to cry or talk to the family.

It made me feel incomplete.

Feeling humbled
Recently I got a letter from a urologist regarding a former patient of mine, Robin.

Robin was diagnosed with prostate cancer about 10 years ago, when I was still his physician. Obviously, the new urologist didn’t know that I had retired. So I forwarded the note to Robin’s new family physician and called Robin to see how he was.

I still felt a tremendous sense of responsibility for Robin’s diagnosis. I had never screened him for prostate cancer. But as he reminded me at the time of his diagnosis, he and I had discussed screening. It’s just that Robin, who knows much about medicine and was always involved in his own decisions, had chosen not to pursue it.

Now 10 years later, Robin and I were catching up. As we talked, Robin revealed that he had multiple complications requiring permanent catheters and that he’d had to give up work.

“I wish you were still in practice,” he said to me. “I miss our talks.”

With that, I felt humbled.

Talking to Robin got me thinking. As doctors, we spend so much time worrying about doing the right thing and giving the right advice that we sometimes forget that we need to have confidence in our patients and their ability to make their own decisions. We need to know when to let go.

“Being there”
Jane was another person who emerged from my professional past. I had known her for years. Not only was she my patient, but I saw her when she came in with her father, sister, and mother for their appointments. Together, we had cared for her family members through their illnesses and deaths.

One day after my retirement, she called to get some advice for a problem she was having with her stepson. I listened, gave some suggestions about whom to see, and offered to stay in touch. She thanked me, saying she didn’t know who else to call.

I hung up thinking how hard it is to “be there” when you are not there.

Jane’s call reminded me of a lesson I’d given years ago to a class of first-year medical students. I had brought in a patient of mine and together, in front of the class, we discussed the doctor-patient relationship.

I asked my patient what was most important about our relationship. She said that when she was diagnosed with diabetes, I gave her my private home phone number.

I responded, “Mrs. E, in our 15 years together, how many times have you used that number?”

“None,” was her reply.

Med students, take note

I really don’t know if my retirement has been easier for my patients than for me. I certainly hope so. Part of my job was to encourage their independence and self-sufficiency. My emotional dependence on them is my problem and I suspect one that is not that uncommon among doctors. I am still teaching and doing some research. Some of my retired friends still go to grand rounds and travel to medical meetings, even though they don’t see any patients.

I have few regrets in retiring from my practice. It was the right thing to do at the right time. Do I miss it every day? Yes, but I also feel so lucky to have worked as a family physician for 42 years.

I once heard a British family physician define the family doctor as someone you can go to and talk to about anything you want. To me, the family doctor is someone who knows you—really knows you—in a way that no one else does. A family doctor is someone who can cry with a patient about a loss, not because the physician can appreciate the loss, but because the patient’s loss is the physician’s loss, too.

I wish more young medical students understood the depth of the connections we make as family physicians, and just how rewarding the work can be. If they did, there would certainly be more students choosing a career in family medicine.

References

  1. Balint M. The Doctor, His Patient and the Illness. 1st ed. London, England: Pitman Medical; 1957.
  2. Loxterkamp D. Being there: on the place of the family physician. J Am Board Fam Pract. 1991;4:354-360.

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*Joel Merenstein is a life-long friend. We met at ages 14, were in the same Jewish boys club, went to Pitt, and since then have stayed in close touch through family events including vacations, visits to one another, and weekly phone calls. We have often had conversations (and continue to do so) about doctors and teachers, technologies in both professions, politics, religion, families, and many other issues. Our friendship has become family.

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Part 2: Draining the Semantic Swamp of “Personalized Learning” : A View from Silicon Valley

In Part 1, based on what I have seen in 17 teachers’ classrooms in eight schools, I tried to explain what I observed by offering a “personalized learning” continuum. As small as the sample is–I will continue with the project in the Fall and add more classrooms and schools–I wanted to take a first pass at making sense (for myself and readers) of what I saw in schools located at the heart of technological enthusiasm, Silicon Valley. Let me be clear, I value no end of the spectrum more than the other. I have worked hard to strip away value-loaded words that suggest some kinds of “personalized learning” are better than others.

This “personalized learning spectrum,” I pointed out, is anchored in the tangled history of school reform, the family fight a century ago among those Progressives who were efficiency-driven and behaviorist in their solutions to problems of teaching and learning and fellow Progressives who sought student agency,  growth  of the “whole child,” and democratic schooling solving societal problems. Both wings of educational Progressives tried to uproot the traditional whole-group, direct instruction model dominating public schools then and since.

The efficiency-driven, behaviorist wing of the Progressives was victorious by the 1930s and has largely dominated school reform since. Innovations appeared each decade trumpeting the next new thing that would make teaching and learning more efficient and effective. In the 1950s, it was “programmed learning machines” (launched by behavioral psychologist, B.F. Skinner); in the 1970s, it was “mastery learning” (anchored in the work of University of Chicago psychologist Benjamin Bloom) followed by “competency-based” learning in the 1980s. Each of these innovations, in different guises, continue to be found in schools in 2016. In all instances, past and present, psychologists and school reformers broke down knowledge and skills into its small, digestible parts so students could learn at their own pace through individualized lessons and teacher use of “positive reinforcement.” Extrinsic rewards from teachers and, later, software programs, guided students along paths to acquiring requisite skills and knowledge. Promoters of these innovations claimed that these approaches were both efficient and effective in getting students to acquire prescribed content and skills, graduate,  enter the labor market, and become civically engaged adults.

Challenges to this dominant approach to teaching and learning occurred periodically from the student-centered, “whole child” wing of the Progressives who championed project-based teaching, student participation, and collaborative learning to achieve the same desired ends. While these determined efforts to individualize lessons to match academic and ability differences among students and create more student agency in lessons and units rose and fell over the years (e.g., the 1960s, 1990s) incrementally increasing within more and more schools, the dominant efficiency-driven whole-group, teacher-directed approach prevailed.

What has happened recently, however, is that those efficiency-minded school reformers, filled with optimism about the power of new technologies to “transform” teaching and learning, have appropriated the language of “whole child” Progressives.  Imbued with visions of students being prepared for a world where adults change jobs a half-dozen times in a lifetime, these efficiency-minded reformers tout schools that have tailored lessons (both online and offline) to individual students, turned teachers into coaches, and where students collaborate with one another thus reflecting the changed workplace of the 21st century. Efficiency-minded reformers’ victorious capture of the vocabulary of “personalized learning”  has made parsing the present-day world of school policies aimed at making classrooms havens of “personalized learning” most confusing to those unfamiliar with century-old struggles over similar issues.

Now consider the “personalized learning spectrum,” my first pass at making sense of this world I observed in Silicon Valley. At one end are teacher-centered lessons and programs tailored for individual students to progress at that own speed. Such “personal” instructional materials and teaching seek efficient and effective learning using a behavioral approach rich in positive reinforcement that has clear historical underpinnings dating back nearly a century. At the other end of the continuum are, again, century-old efforts to create student-centered whole- and small-group lessons and programs that seek student agency and shape how children grow cognitively, psychologically, emotionally, and physically.  And, of course, on this spectrum hugging the middle of the range are hybrids mixing the two approaches. To get at this spread in 2016 within the eight schools I visited and 17 teachers I observed, I will give examples drawn from earlier posts on this blog and instances elsewhere in the U.S.  of each end of the spectrum and ones that inhabit the center.

At the behaviorist pole of the spectrum where skill-driven lessons tailored to differences among students cluster, different public schools and districts* drawn from across the nation exist such as  New Hampshire Virtual Learning CharterUSC Hybrid High School, and Lindsay Unified School District (California). While these examples inhabit the behaviorist end of the continuum they are not cookie-cutter copies of one another–USC Hybrid High School differs in organization and content from New Hampshire Virtual Learning Charter. Yet I locate these schools and districts at this end of the spectrum because of their overall commitment to using existing online lessons (or crafting their own) anchored in discrete skills and knowledge, aligned to the Common Core standards, and tailored to the abilities and performance of individual students. Even though these schools and programs have appropriated the language of student-centeredness and encourage teachers to coach individuals and not lecture to groups, even scheduling student collaboration during lessons, their teacher-crafted playlists that vary for each student accompanied by assessments of skills and knowledge locates them here. And, finally, these programs seek the ends of thoughtful, fully engaged, and whole human beings–the same as other programs along the spectrum. And they still operate within the traditional format of K-8 and 9-12 age-graded schools

In the middle of the spectrum would be classrooms, schools and districts that have blended learning models (there are more than one) combining personalized lessons for individual students and teacher-directed classroom lessons such as ones taught by Aragon High School Spanish teacher, Nicole Elenz-Martin  and second-grade teacher Jennifer Auten at Montclaire Elementary School in Cupertino (CA) into blends of teacher- and student-centered lessons. Urban Rocketship schools in Silicon Valley, for example, has students working on online math and literacy software geared to questions  students will face on tests. They sit in cubicles for part of the day followed by chunks of time spent in classrooms where teacher-directed lessons occur.

The middle school math program I observed called Teach To One located in an Oakland (CA) K-8 school has different “modalities” that place it also in the center of the spectrum as well, tilting a bit toward the behaviorist end with its numbered math skills that have to be mastered before a student moves on. Also in Oakland is James Madison Middle School using a rotational version of blended learning for its 6th through eight graders.

I would also include teachers in the two Summit Charter schools I observed (Summit Prep–here–and Summit Rainier–here) who combined project-based teaching, online readings and self-assessments, individual coaching and collaborative work within 90-minute lessons. While Summit schools in which I observed teachers had explicitly committed itself to “project-based learning,” the projects were largely chosen by the teachers who collaborated with one another in making these decisions for all Summit schools; the projects were aligned to the Common Core state standards. While choices were given to students within these projects for presentations, reading materials, and other assignments, major decisions on projects were in teachers’ hands (the nine classes I observed at Summit schools were, for the most part, lodged at the second stage  (see here) of putting project-based learning into practice. This is why I placed these teachers and schools in the center of the continuum.

Such schools mix competency-based, individual lessons for children in large cubicle-filled rooms with teacher-directed lessons, project-based teaching. Like those at the behaviorist end, these programs lodged in the center of the spectrum contain differences among them. Yet they all work within the traditional age-graded school organization.

At the pole opposite the behaviorist end is the student-driven, “whole child” set of arrangements that prize multi-age groupings, high student participation in their learning through working on projects that both student and teacher develop, cultivate cross-disciplinary linkages, and dispense with age-graded arrangements (sometimes called “continuous progress”). Many of these schools claim that they “personalize learning” in their daily work to create graduates who are independent thinkers, can work in any environment, and help to make their communities better places to live. There are less than two-score of these schools nationally.

For example, there is High Tech High in San Diego that centers its instruction around project-based learning (and, from documents and exhibits, seem to be at the fourth stage of PBL). The teacher-led Avalon charter school in St. Paul (MN) relies on PBL implementing it through individualized learning plans. The Mission Hill School in Boston (MA), The Sycamore school in Claremont (CA), the Open Classroom at Lagunitas Elementary in San Geronimo (CA), the Continuous Progress Program at Highlands Elementary in Edina (MN)–all have multi-age groupings, project-based instruction, and focus on the “whole child.” And there are private schools such as The AltSchool, a series of small private schools located in big cities and the Khan Lab School (Mountain View, California) fit here as well. They say that they, too, “personalize learning.” Like the clusters of programs at the other end of the continuum and in the middle, much variation exists among these schools harbored here.

In the few months I observed schools and classrooms in Silicon Valley, I saw instances of technology being integrated into lessons and school programs aimed at achieving larger purposes of public schooling mentioned above. However, I saw no examples among these schools of multi-age groupings, advanced stages of project-based teaching, and other features listed above for this end of the continuum.

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These two posts are my first effort to make sense of the uses of technology to “personalize learning” that I have seen over the past few months in Silicon Valley schools and classrooms. Highly recommended to me as instances of teachers and schools that integrate technology seamlessly into their daily work, I found that their uses of technology to teach content and skills through “personalizing Learning” fell into types of programs that I could array along a continuum. All of these schools sought similar ends of producing graduates who could be problem-solvers, find jobs in a competitive labor market and become engaged in their communities.

I would appreciate comments from viewers about this first pass at understanding what I observed in these classrooms and schools. I welcome comments on the clarity (or lack of it), coherence (or lack of it) and helpfulness (or lack of it) of this spectrum in draining the semantic swamp of “personalized learning.”

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*None of the 17 teachers I observed taught wholly online so I do not include any examples here. Many of the teachers I watched, however, used a combination of online resources, teacher-directed lessons, and small-groups to “personalize learning” while conveying prescribed knowledge and skills aligned to Common Core standards adopted by the state of California.

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Draining The Semantic Swamp of “Personalized Learning”–A View from Silicon Valley (Part 1)

No surprise that a catch-phrase like “personalized learning,” using technology to upend traditional whole group  lessons, has birthed a gaggle of different meanings. Is it  updated “competency-based learning?” Or “differentiated learning” in new clothes or “individualized learning” redecorated?  (see here, here and here). Such proliferation of school reforms into slogans is as familiar as photos of sunsets. “Blended learning,” “project-based teaching,” and “21st Century skills” are a few recent bumper stickers–how about “flipped classrooms?”– that have generated many meanings as they get converted by policymakers, marketeers, researchers, wannabe reformers, and, yes, teachers into daily lessons.

For decades, I have seen such phrases become semantic swamps where educational progressives and conservatives argue for their version of the “true” meaning of the words. As a researcher trained in history, since the early 1980s, I have tracked policies as they get put into practice in schools and classrooms.  After all, the first step in science is to observe systematically the phenomenon or as Yogi Berra put it: “You can observe a lot by watching.” The second step is to describe and tell others what was seen and explain it.

Over the past few months, I have visited eight schools and 17 teachers in “Silicon Valley,” that near-mythical stretch of the Bay area in Northern California encompassing San Jose, San Francisco, and Oakland and their environs. I went into schools and classrooms that administrators, policymakers, researchers, and others identified for me as “best cases,” or exemplars of integrating use of technology into daily lessons. Many, but not all, told me that they had integrated technology into their lessons to “personalize learning.”

The questions I asked myself while observing a class was simply: What are teachers and students doing when computer use is integrated into a lesson? Toward what ends is such use aimed?

Teachers and principals invited me to observe.  There were no tours or group visits. I went to each school and talked with principals, various teachers, and read online documents describing the school. I sat in 90-minute lessons, listened to students in and out of class–even shadowing a student at one school for a morning–and took copious notes.  I sent drafts of my classroom observations to teachers to correct any errors in facts that I made. Then I published accounts of my observations  in my blog in March, April, and May 2016.  Although I am far from finished in this project, now is the time for that second step (see above). I need to make sense of  what I saw at the epicenter of technological optimism. So this is an initial pass at figuring out what I saw as I sloshed through the semantic swamp of  “personalized learning.”

The “Personalized Learning” spectrum

When I visited the schools, administrators and most teachers told me that they were “personalizing learning.” What I saw, however, in classrooms and schools was a continuum of different approaches–which I call the “personalized learning spectrum”–that encompassed distinct ways of implementing technology in lessons to reach larger purposes for schooling. Let me be clear, I value no end of the spectrum (or the middle) more than the other. I have worked hard to strip away value-loaded words that suggest some kinds of “personalized learning” are better than others.

At one end of the continuum are teacher-centered lessons and programs within the traditional age-graded school using behavioral approaches that seek efficient and effective learning to make children into knowledgeable, skilled, and independent adults who can successfully enter the labor market, thrive, and become adults who help their communities. These approaches (and ultimate aims for public schools) have clear historical underpinnings dating back nearly a century.

At the other end of the continuum are student-centered lessons and programs that seek student agency and shape how children grow cognitively, psychologically, emotionally, and physically. They avoid the traditional age-graded arrangements that they believe have deadened learning for over a century. Their overall goals of schooling are to convert children into adults who are creative thinkers, help out in their communities, enter jobs and succeed in careers, and become thoughtful, mindful adults. Like the other end of the spectrum, these approaches have a century-old history as well.

And, of course, on this spectrum hugging the middle are hybrids mixing behavioral and cognitive approaches aimed at turning children into adults who engage in their communities, are creative, thoughtful individuals who succeed in the workplace.

Such a spectrum has been around for many decades with different names such as “Progressive-to-Traditional,” “Teacher-centered to Student-centered, etc. A glance at the rear-view mirror about the history of these continua helps me make sense of what I saw in my observations..

Looking back a century

What today’s reformers promoting “personalized learning” have to remember are their yesteryear cousins among Progressive reformers a century ago. Then, these reformers wanted public schools to turn children and youth into thoughtful, civically engaged, whole adults. Those early Progressives drank deeply from the well of John Dewey but ended up following the ideas of fellow Progressive Edward Thorndike, an early behaviorist psychologist and expert in testing.*

If one wing of these early progressives were pedagogical pioneers advocating project-based learning, student-centered activities, and connections to the world outside of the classroom, another wing of the same movement were efficiency-minded, “administrative progressives,” who admired the then corporate leaders of large organizations committed to both efficiency and effectiveness–Standard Oil, U.S. Steel, General Motors. Thorndike at Columbia University’s Teachers College, Ellwood P. Cubberley at Stanford and other academics, in alliance with the new field of educational psychology, borrowed heavily from business leaders. They counted and measured everything in schools and classrooms under the flag of “scientific management.” They reduced complex skills and knowledge to small chunks that students could learn and practice. They wanted to make teachers efficient in delivering lessons to 40-plus students with the newest technologies of the time: testing, film, radio. They created checklists for teachers to follow in getting students to learn and behave. They created checklists for principals to evaluate teachers and checklists for superintendents to gauge district performance including where every penny was spent.

A century ago, this efficiency-minded, behaviorist wing of the progressive movement overwhelmed the pedagogical progressives passionate about students developing and using a range of cognitive and social skills. Thorndike trumped Dewey.

Now in 2016 behaviorists and believers in the “whole child” wear the clothes of school reformers and educational entrepreneurs. They tout scientific studies showing lessons tailored for individual students produce higher test scores than before, or that project-based learning creates independent, creative, and smart students.

What exists now is a re-emergence of the efficiency-minded “administrative progressives” from a century ago who now, as entrepreneurs and practical reformers want public schools to be more market-like where supply and demand reign, and more realistic in preparing students for a competitive job market. Opposed are those who see schools as places to create whole, knowledgeable human beings capable of entering and succeeding in a world far different than their parents faced. The struggle today is between re-emergent, century-old wings of educational progressives. It is, then, again a family fight.

Part 2 will place some of the classroom lessons and schools I observed and have documented elsewhere along that continuum.

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*A current dust-up between Progressives and Conservatives over school reform (see Rick Hess’s summary of back-and-forth bloggers here) misses entirely the intra-reformer struggle among Progressives a century ago and how the conservative, efficiency-driven wing (e.g., Edward Thorndike, et. al.) of those early Progressives triumphed over the liberal, student-centered, reconstructionist wing (e.g., John Dewey, George Counts, et. al.) who sought to make  schools student-centered and agents of societal reform. David Tyack tracked this split fully in The One Best System and with co-author Elisabeth Hansot in Managers of Virtue. The split that Hess and others see today is hardly new. It is a resurgence of that old struggle among Progressives but now reincarnated in an age of standards, testing, and accountability. The  split among current school reformers is over  both equity and efficiency with one wing labeled “Progressives” and the other “Conservatives.” Current “Progressives,” imbued with social justice, want schools to be agents of social and political change and student-centered. They use both behaviorist and cognitive approaches to “personalize learning.”  “Conservatives” want contemporary reform policies (e.g., charters, standards and accountability) to be sustained because they advance equity and blend technology to create both student- and teacher-centered experiences. They, too, want learning to be “personalized” and create  both behaviorist- and cognitive-driven lessons.  Such clashes  track earlier differences among reformers a century ago. The conflict today, as then, tries to answer the age-old question: Is the job of public schools in a democratic and capitalist-driven society to solve larger economic, social, and political problems that the nation faces or focus on building whole human beings who can thrive and succeed in a highly competitive society?

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Substance Beats Flash: District Superintendents and Minority Achievement Network (S. David Brazer and Robert G. Smith)

A former high school principal, David Brazer is Associate Professor (Teaching) and Faculty Director of Teaching Leadership Programs at Stanford University; former superintendent of the Arlington (VA) public schools, Robert Smith is Associate Professor of Educational Leadership at George Mason University. They co-authored Striving for Equity (2016).

 

 

The contemporary education reform climate seems to value flash over substance, grand ideology over hard work, and narrow quantitative impact over steady progress in nurturing environments. Lost in all this noise is the steady effort of school board members, superintendents, principals, teachers, students, and parents striving to make the most out of school-age years, from pre-school through high school graduation. The gross exaggerations of “the schools are failing” or “this will revolutionize education” are exposed by the deliberate, effective approaches to improving student achievement of 13 superintendents who tell their stories in Striving for Equity: District Leadership for Narrowing Opportunity and Achievement Gaps (Harvard Education Press, 2016). They pursued results rather than headlines.

Instead of chasing a “best practices” holy grail, these superintendents worked with their communities—both within and around their inner-ring suburban school districts—over long periods of time, following a series of steps that adhered to their commitment to equity and reflected their practical experiences as education leaders. They began by helping parents, teachers, and board members understand that inequities were embedded in their districts’ student outcomes. Most of them were ahead of their time, recognizing opportunity and achievement gaps long before these terms were widely used. Publicizing the data demonstrating achievement differences between the majority population and students with disabilities, in poverty, speaking languages other than English, or identifying as non-white helped these superintendents rally their communities to their gap-closing agendas.

Many of the tactics superintendents employed were pedestrian in nature—funding pre-school, unifying elementary curricula, and keeping their boards educated on the nature of the problem and district progress. Other actions were more complicated, such as providing professional development so that teachers were better equipped to implement curricular changes and reach changing student populations. Additionally, these superintendents also took substantial risks when they focused their professional staffs on understanding unintended bias and institutionalized racism, dismantled entrance requirements for their districts’ most challenging courses, or addressed poverty by taking programs into housing projects or working with health insurance companies to provide coverage for impoverished students. There were no magic bullets or secret sauces, just sensible policies and procedures that focused their agendas to narrow opportunity and achievement gaps for all of their districts’ students.

We identified this group of dedicated superintendents based on their membership on the Governing Board of the Minority Student Achievement Network (MSAN). MSAN, as the name suggests, is committed to success for students who stand outside the majority population on at least one dimension. All of the superintendents valued MSAN for its ability to bring together colleagues and their students from across the country to share ideas and stimulate each other’s thinking about how to address the persistent gaps that dog public education. They attribute many of their good ideas to stimulation that came from MSAN meetings, but no one believed that MSAN provided specific tactics to be implemented. Instead, sharing successes and setbacks and learning from peers, superintendents tended to focus on the principles undergirding shared initiatives rather than trying to replicate particular recipes or procedures. This approach led to innovations adapted and tailored to their specific school districts.

The common experiences of these superintendents highlight central challenges of the job for those who seek to have schools and school systems live up to their equalization potential in US society. The superintendents continually balanced competing demands on resources, shifting politics, and the need to demonstrate progress so that they could remain in their posts long enough to see the effects of their carefully crafted changes and programs. Not all of them stayed more than four or five years, but those who did were able to demonstrate important transformations in their school districts that were making a difference for students long marginalized in their systems. Their examples point to two important factors that are uncommon in public school districts today: 1) longevity in the superintendent role supports long-term improvement, and 2) meaningful reform is multi-faceted, requiring strategy, time, and resources to take hold.

Each of the 13 superintendents pointed with pride to major accomplishments that narrowed achievement gaps in their school districts. None, however, could claim to have closed any of the gaps they identified. Any educator who has tried at any level to help a child succeed will understand that moving the needle on achievement is a thorny, baffling process with many stumbling blocks. Long after the fad or reform du jour has passed from the scene, superintendents, teachers, principals, and other educators dedicated to equitable student outcomes will be chipping away at the gaps in their schools and districts, eventually eliminating minority status as a predictor of student achievement. These superintendents lead the way to that more promising future.

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This Ed-reform Trend Is Supposed To Motivate Students; Instead, It Shames Them (Launa Hall)

Nearly all reform policies have consequences, intended and unintended, regardless of how well-meaning, empathic, and mindful policymakers may be. The following essay of a former elementary school teacher illustrates the unintended consequence of a familiar reform-driven policy. A former teacher, Launa Hall lives in Northern Virginia and is working on a book of essays about teaching. This essay appeared in the Washington Post, May 19, 2016 

My third-graders tumbled into the classroom, and one child I’d especially been watching for — I need to protect her privacy, so I’ll call her Janie — immediately noticed the two poster-size charts I’d hung low on the wall. Still wearing her jacket, she let her backpack drop to the floor and raised one finger to touch her name on the math achievement chart. Slowly, she traced the row of dots representing her scores for each state standard on the latest practice test. Red, red, yellow, red, green, red, red. Janie is a child capable of much drama, but that morning she just lowered her gaze to the floor and shuffled to her chair.

In our test-mired public schools, those charts are known as data walls, and before I caved in and made some for my Northern Virginia classroom last spring, they’d been proliferating in schools across the country — an outgrowth of “data-driven instruction” and the scramble for test scores at all costs. Making data public, say advocates such as Boston Plan for Excellence, instills a “healthy competitive culture.” But that’s not what I saw in my classroom.

The data walls concept originated with University of Chicago education researcher David Kerbow, who in the late 1990s promoted visual displays to chart students’ progress in reading. Kerbow called these displays “assessment walls,” and he meant them to be for faculty eyes only, as tools for discussion and planning. But when that fundamentally sound idea met constant anxiety over test scores in K-12 schools across the United States, data walls leaked out of staff-room doors and down the halls. Today, a quick search on Pinterest yields hundreds of versions of children’s test scores hung in public view.

Diving Into Data,” a 2014 paper published jointly by the nonprofit Jobs for the Future and the U.S. Education Department, offers step-by-step instructions for data walls that “encourage student engagement” and “ensure students know the classroom or school improvement goals and provide a path for students to reach those goals.” The assumption is that students will want to take that path — that seeing their scores in relationship to others’ will motivate them to new heights of academic achievement. They are meant to think: “Oh, the green dots show my hard work, yellow means I have more work to do, and red means wow, I really need to buckle down. Now I will pay attention in class and ask questions! I have a plan!”

How efficient it would be if simply publishing our weaknesses galvanized us to learn exactly what we’re lacking.

That late night when I got out my markers and drew the charts, I rationalized that it was time to drop all pretenses. Our ostensible goal in third grade was similar to what you’d hear in elementary schools everywhere: to educate the whole child, introduce them to a love of learning and help them discover their potential. We meant that wholeheartedly. But the hidden agenda was always prepping kids for the state’s tests. For third-graders, Virginia has settled on 12 achievement standards in reading and 20 in math, each divided further into subsections. And once blossoms were on the trees, we were just a few weeks from the exams that would mark us as passing school or a failing one. We were either analyzing practice tests, taking a test or prepping for the next test. Among the teachers, we never stopped talking about scores, and at a certain point it felt disingenuous not to tell the kids what was really going on.

I regretted those data walls immediately. Even an adult faced with a row of red dots after her name for all her peers to see would have to dig deep into her hard-won sense of self to put into context what those red dots meant in her life and what she would do about them. An 8-year-old just feels shame.

Psychologists Todd Kashdan and Robert Biswas-Diener point out in their book “The Upside of Your Dark Side ” that while some uncomfortable feelings can be useful, shame is not productive. Guilt, they say, can encourage people to learn from their mistakes and to do better. In contrast, “people who feel shame suffer. Shamed people dislike themselves and want to change, hide, or get rid of their self. ”

It also turns out that posting students’ names on data walls without parental consent may violate privacy laws. At the time, neither I nor my colleagues at the school knew that, and judging from the pictures on Pinterest, we were hardly alone. The Education Department encourages teachers to swap out names for numbers or some other code. And sure, that would be more palatable and consistent with the letter, if not the intent, of the Family Educational Rights and Privacy Act. But it would be every bit as dispiriting. My third-graders would have figured out in 30 seconds who was who, coded or not.

The data walls made it harder for me to reach and teach my students, driving a wedge into relationships I’d worked hard to establish. I knew Janie to be an extremely bright child — with lots of stresses in her life. She and I had been working as a team in small group sessions and in extra practice after school. But the morning I hung the data walls, she became Child X with lots of red dots, and I became Teacher X with a chart.

Of course, I tried to mitigate the shame she felt. I let her loudly sing a song she made up, and I made time for one of our conversations on the playground. Did my efforts at reconnection help? Maybe a little. But she still had all those red dots for everyone to see.

It’s hard to find research that supports public data walls. In fact, studies suggest that rather than motivating students, they may be detrimental. “Evaluation systems that emphasize social comparison tend to lower children’s perceptions of their competence when they don’t compare favorably and cause them to engage in many self-defeating cognitions and experience considerable negative affect,” according to Carole Ames, a leading scholar of social and academic motivation and a professor emeritus at Michigan State University.

In an article published in March in the journal Educational Policy, Julie Marsh, Caitlin Farrell and Melanie Bertrand warn against data walls and similar practices that stress competition and achievement rather than meaningful learning. They note that federal education policy has “long emphasized status measures of student achievement (i.e., proficiency) and assumed that public reporting of information on performance, coupled with consequences, will motivate individuals to work harder and differently to improve performance.” Now, they observe, that focus on achievement and mistaken assumptions about motivation have trickled down to the classroom. Their study of six middle schools found that “many well-intentioned teachers . . . appeared to be using data with students in ways that theoretically may have diminished the motivation they initially sought to enhance.”

And consider exactly who is being shamed by data walls. Janie is part of an ethnic minority group. She received free breakfast and lunch every school day last year, and some days that’s all she ate. Her family had no fixed address for much of the year, and Janie, age 8, frequently found herself the responsible caretaker of younger siblings. That’s who is being shamed.

And do you see those neat rows of green dots on the chart? If you haven’t already guessed, they belong to children whose families have the resources for new shoes and fresh fruit and a little left over for a modest vacation from time to time, children whose parents attend teacher conferences with their forms not only signed but stapled to a list of questions about how to help with homework.

When policymakers mandate tests and buy endlessly looping practice exams to go with them, their image of education is from 30,000 feet. They see populations and sweeping strategies. From up there, it seems reasonable enough to write a list of 32 discrete standards and mandate that every 8-year-old in the state meet them. How else will we know for sure that teaching and learning are happening down there?

But if we zoom in, we see that education actually happens every weekday, amid pencils and notebooks, between an adult and a small group of youngsters she personally knows and is deeply motivated to teach. Public education has always been — and needs to be still — a patchwork of ordinary human relationships. Data walls, and the high-stakes tests that engender them, aren’t merely ineffective, they break the system at its most fundamental level. They break the connection between a teacher who cares and a kid who really needs her to care.

Teaching the young wasn’t supposed to feel like this. When we imagine the ideal elementary school, we see walls covered with things the kids made. We see kids clustered around tadpoles and taking notes in crooked, exuberant handwriting. We hear “Oh, wow!” from teachers and children alike, and the murmur of many voices talking it over and figuring it out. We smell grass stains on sweaty little kids because they just ran in from a long romp outdoors. And why shouldn’t our elementary schools be what we wish for? The whole ideal of school, this particular means to pass our accumulated human knowledge from one generation to the next, is a construct we made up. Why not make it wonderful? Why not make it work?

We are failing our kids. The writing is on the wall.

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Proof Points: Selling and Marketing “Blended Learning” to Educators and Parents

I have discovered the phrase “proof points” recently. I had known of “proof for existence” in arguments about God. I had known about the history of math proofs. But “proof points” in marketing digital technologies to schools, well, that was new to me.

So I looked up “proof points” and found that they are a favored marketing tool.

“Proof points are one of the four elements of a classic brand positioning, and are important for making points of difference believable. They provide credibility and support for the Key Points of Difference.”

Or this “monster list” infographic  that a blogger found citing  dozens of “proof points” for marketeers to use :

AAEAAQAAAAAAAAdzAAAAJGFlNDYzZjY2LTkwZTMtNDlkNS1iYzU5LTkzN2YwMmNmOWU5Yw

“Proof points” are common when the subject turns to technologies in schools. Here is one example of the extent that selling new technologies have seized the school market–$nearly 700 billion for K-12 schooling.  Proof points: Blended learning success in school districts, is a publication  that summarizes 12 case studies of schools and districts in the U.S. “Each short profile,” the article says,  “highlights key details in the district’s blended-learning strategy, the EdTech products used, and promising results in the form of test scores and graduation rates.”

Here are a few of the case studies the Clayton Christensen Institute for Disruptive Innovations, an organization devoted to spreading “blended learning,”  published last year.

Spokane, Washington, has developed and implemented blended learning in numerous programs across the district with a goal of increasing graduation rates and college and career readiness. Since implementing blended learning, the district’s graduation rate has increased from 60% in 2007 to 83% in 2014.
Hamilton County Community Unit School District 10, McLeansboro, Illinois, began offering blended learning during the 2012–13 school year as a way to shift its instructional model from whole-group instruction to personalized learning. An evaluation based on NWEA MAP scores shows students in grades using blended learning outperforming students in grades not using blended learning.
Spring City Elementary Hybrid Learning School, Spring City, Pennsylvania, uses a three-station Station Rotation model of blended learning. It has seen improved test scores in math, reading, and science since implementing its blended-learning program.
A casual reading of these three (see the other nine to determine how typical these are) make clear that the introduction of some form of “blended learning” caused scores and high school graduation rates to improve. By combining them in the same sentence–“blended learning” and improved metrics–the clear intent is not merely suggestive but forcefully states that one led to the other. That kind of sliding from description to “proven” solution is common in the ads we see when Googling as ads appear in our peripheral vision. Or watch TV ads for miracle drugs.  I assume that the metrics on improved test scores and graduation rates are accurate but, (and here is a huge “but” that should be capitalized) other factors can explain such improved outcomes than the onset of “blended learning.”
Not coming into play are key factors that have long influenced teacher and student outcomes. Consider the demography of students in families in the school and district. Or previous non-technological reforms of a decade or longer that altered existing curriculum, provided community services, and focused on building teacher expertise and skills. Or sustained leadership over a decade. Or altered pedagogies. And there are others yet all go unmentioned in the reductionist “proof points.”
What these “proof points” do, then, is reduce the complexity of schools as organizations where power, influence, relationships, and demography interact daily while avoiding the obvious point that tax-supported public schools are dissimilar to command-and-control operations in business.
From time to time, within the sales and marketing communities, warnings appear about such over-stated claims and shortcomings of “proof points.”  From a “Marketing Boot Camp” blog:
“It’s not enough to say you have studies to prove your claims. Elaborate on how the studies were uniquely conducted to shed light on the product’s proprietary formula so that it works more effectively. “
Or from a blogger on marketing for the well-known Gartner group:
“If you’re bombarded as much as most marketers are with pushed content, then you’re probably skeptical of one more claim for the “next big thing”. Every marketing technology and service provider, every specialized association and publication, and every “independent” pundit has at one time or another proclaimed the “next big thing” you need to pay attention to – and of course invest in. Even when they present proof points, I take the claims with a grain (sometimes a heaping teaspoon) of salt.”
But these occasional challenges to “proof points” are drowned out by marketing practices that have become mainstream in educational products and services. Such shabby logic in using “proof points” befits a carnival barker, not thoughtful and careful marketeers. Yes, it is slippery thinking transferred from the world of sales to the huge school market especially when new technologies are touted to improve teaching and learning. Nearly 35 years after A Nation at Risk roused reformers to tie education to the economy, sales and marketing pitches have grown to become as common as laptops in schools.

 

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Confessions of a Luddite professor (Daniel Drezner)

Daniel W. Drezner is a professor of international politics at the Fletcher School of Law and Diplomacy at Tufts University. This post appeared in the Washington Post on April 28, 2016.

 

I had the good fortune on Wednesday to hear economist Robert Gordon talk about his magnum opus, “The Rise and Fall of American Economic Growth.” Gordon has a somber tale to tell. He argues that U.S. economic growth ain’t what it used to be, and that ain’t gonna change over the next 25 years. This is due to myriad headwinds such as demographic slowdowns, rising inequality, fiscal constraints, and — most important — the failure of newer technologies to jumpstart economic growth the way that the Second Industrial Revolution did.

It’s his last point — about the effect of information technology on productivity — that prompts so much fierce debate.  Economists are furiously debating whether the visible innovations in the information sector are leading to productivity advances that are going undetected in the current productivity statistics. On the one hand, the aggregate data suggests a serious productivity slowdown over the past decade. On the other hand, Google’s chief economist, Hal Varian, insists that “there is a lack of appreciation for what’s happening in Silicon Valley, because we don’t have a good way to measure it.”

Surely, there are sectors, such as higher education, in which technological innovations can yield significant productivity gains, right? All that talk about MOOCs and flipped classrooms and the like will make a difference in productivity, yes?

As an optimist, I’ve long resisted Gordon’s argument — but this is one area where I’m beginning to suspect that he’s right and Silicon Valley is wrong.

I’ve been teaching for close to 20 years now. During that time, the IT revolution has fundamentally transformed what I do on a day-to-day basis. It is massively easier for me to access data that helps inform my classes. The ability to use audio-visual methods to broadcast a video or audio to my students is much easier. I’ve Skyped in as a guest lecturer for numerous other colleagues. Course websites have made it far easier for me to communicate with my students, and for them to communicate with me. There is no denying that on some dimensions, technological change has made it much easier for me to do my day job.

And yet, over the past decade, I have also gone in a more Luddite direction. After having a laissez-faire policy on laptops in my classrooms for my first decade of teaching, I have pretty much banned them. I knew that taking notes by hand is much, much better for learning than taking notes on a computer (the latter allows the student to transcribe without thinking; the former forces the student to cognitively process what is worthy of note-taking and what is not), but I figured that was the student’s choice. The tipping point for me was research showing that open screens in a classroom distract students close to the screen. So I went all paternalistic and decided to eliminate them from my classroom. The effect was immediate — my students were more engaged with the material.

My lectures are pretty low-tech as well. I use videos in class on occasion, but I usually deploy them at the start and then start lecturing. Otherwise lights have to be dimmed and that’s an invitation for the student to tune out. Similarly, I don’t use Powerpoint for my notes — because that just invites the student to transcribe the points in the slide without thinking about them.

One could argue that Skyping in as a guest lecturer, or just broadcasting a superstar professor into other universities, could improve the quality of the classroom experience. But I doubt it. Speaking from experience, lecturing remotely is a radically imperfect substitute for interacting in the same physical space. A mediocre but in-the-flesh-professor still provides a superior education environment than a remote lecturer that one watches on a screen.

There has been one innovation over the past generation that has made my in-class teaching better. The whiteboard is way better than the blackboard to use. Otherwise, I have become warier of new technologies in the classroom.

Maybe this is just me being a Luddite, and, as digital natives, millennial professors will figure out how to properly exploit information technologies in the classroom. And outside of the classroom, I’m a pretty big fan of these new technologies.

But when it comes to higher education, I think Gordon is right and Varian is wrong. There are gains to be wrung from technological innovation — but they’re much more limited than Silicon Valley wants you to believe.

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