Mention progress in medicine, business, and education and the first thought is usually getting new technologies that are faster, better, and more efficient than current ones. New drugs and new communication devices cure diseases and speedily digest information to make breakthroughs in better health, increase productivity, and improve teaching and learning. But even more important to many folks than progress through new technologies are enhancing the capabilities of doctors, CEOs, and educators. “What ultimately makes the difference is how well people use technology. We have devoted disastrously little attention to fostering those abilities.” Surgeon Atul Gawande is correct. And he should know.
A veteran surgeon, Atul Gawande had hit a plateau. As he said: “I compared my results against national data, and I began beating the averages. My rates of complications moved steadily lower and lower. And then, a couple of years ago, they didn’t. It started to seem that the only direction things could go from here was the wrong one.” He was 45 years old. He pointed out that surgery is a “late-peaking career” unlike sports, theater, and mathematics. The average age for hiring CEOs is 52 (for Texas superintendents, the average is 53); geologists, he says, reach maximum productivity around 54. Gawande figured out that surgeons are somewhere in that late-peaking vicinity. So he hired a personal coach.
Robert Osteen, a surgeon who had trained Gawande and for whom he had great respect, agreed to be his coach and watched him perform surgeries. After an operation to remove a tumor from the thyroid gland, Gawande met with Osteen to go over what his former teacher saw, answer questions, and make suggestions.
Gawande thought that “the case went beautifully. The cancer had not spread beyond the thyroid, and, in eighty-six minutes, we removed the fleshy, butterfly-shaped organ, carefully detaching it from the trachea and from the nerves to the vocal cords. Osteen had rarely done this operation when he was practicing, and I wondered whether he would find anything useful to tell me.
“We sat in the surgeons’ lounge afterward. He saw only small things, he said …. He noticed that I’d positioned and draped the patient perfectly for me, standing on his left side, but not for anyone else. The draping hemmed in the surgical assistant across the table on the patient’s right side, restricting his left arm, and hampering his ability to pull the wound upward. At one point in the operation, we found ourselves struggling to see up high enough in the neck on that side. The draping also pushed the medical student off to the surgical assistant’s right, where he couldn’t help at all. I should have made more room to the left, which would have allowed the student to hold the retractor and freed the surgical assistant’s left hand.
“He had a whole list of observations like this. His notepad was dense with small print. I operate with magnifying loupes and wasn’t aware how much this restricted my peripheral vision. I never noticed, for example, that at one point the patient had blood-pressure problems, which the anesthesiologist was monitoring. Nor did I realize that, for about half an hour, the operating light drifted out of the wound; I was operating with light from reflected surfaces. Osteen pointed out that the instruments I’d chosen for holding the incision open had got tangled up, wasting time….
“That one twenty-minute discussion gave me more to consider and work on than I’d had in the past five years. It had been strange and more than a little awkward having to explain to the surgical team why [the retired surgeon] was spending the morning with us. “He’s here to coach me,” I’d said. Yet the stranger thing, it occurred to me, was that no senior colleague had come to observe me in the eight years since I’d established my surgical practice. Like most work, medical practice is largely unseen by anyone who might raise one’s sights. I’d had no outside ears and eyes.”
Most teachers, principals, and superintendents would probably agree with Gawande that “no outside ears and eyes,” ones trusted and respected as the veteran surgeon’s coach were, had seldom looked over their shoulders, took notes, and conferred afterwards.
Coaching is popular today in many districts for beginning teachers and even veteran ones if the schools are on probation or about to be closed. In the New Yorker article, Gawande describes admiringly the coaching work of former teacher Jim Knight of the Kansas Coaching Project. As for superintendents and principals, professional associations and for-profit firms offer “leadership coaches” or “executive coaches.” Coaching has become an industry complete with certification requirements and charlatans. In subsequent posts I will take up coaching for teachers, principals and superintendents.