Category Archives: medicine and schooling

Teachers and Researchers: Searching for the Truth of Classroom Change

I am preparing to write a section in my forthcoming book on technology integration about  the different perspectives that teachers and researchers have on changes in classroom lessons. To do that, I have looked back at the handful of posts I have written since 2009 on this point so I can figure out what to say in this forthcoming book.

Here is one from November 2009 along with a reader’s thoughtful comment (and criticism) of the position I take in the post.

Over the years, I have interviewed many teachers across the country who have described their district’s buying computers, deploying them in classrooms while providing professional development. These teachers have told me that using computers, interactive white boards, and other high-tech devices with accompanying software have altered their teaching significantly. They listed changes they have made such as their Powerpoint presentations and students doing Internet searches in class. They told me about using email with students.Teachers using interactive white boards said they can check immediately if students understand a math or science problem through their voting on the correct answer.

I then watched many of these teachers teach. Most teachers used the high-tech devices as they described in their interviews. Yet I was puzzled by their claim that using these devices had substantially altered how they taught. Policymaker decisions to buy and deploy high-tech devices was supposed to shift dominant ways of traditional teaching to student-centered, or progressive approaches. All of this in years when No Child Left Behind, extensive testing, and coercive accountability reigned. What I encountered in classrooms, however, departed from teachers’ certainty that they have changed how they teach.

I am not the first researcher to have met teachers who claimed substantial changes in their teaching in response to district or state policies. Consider “A Revolution in One Classroom; The Case of Mrs. Oublier.”

In the mid-1980s, California policymakers adopted a new elementary math curriculum intended to have students acquire a deep understanding of math concepts rather than memorizing rules and seeking the “right” answer. The state provided staff development to help elementary teachers implement the new curriculum. Then, researchers started observing teachers using the new math curriculum.

One researcher observed third grade teacher Mrs. Oublier (a pseudonym but hereafter Mrs. O) to see to what degree Mrs. O had embraced the innovative math teaching the state sought. Widely respected in her school as a first-rate math teacher, Mrs. O told the researcher that she had “revolutionized” her teaching. She was delighted with the new math text, used manipulatives to teach concepts, organized students desks into clusters of four and five, and had student participate in discussions. Yet the researcher saw her use paper straws, beans, and paper clips for traditional classroom tasks. She used small groups, not for students to collaborate in solving math problems, but to call on individuals to give answers to text questions. She used hand clapping and choral chants—as the text and others suggested—in traditional ways to get correct answers. To the researcher, she had grafted innovative practices onto traditional ways of math teaching and, in doing so, had missed the heart and soul of the state curriculum.

How can Mrs. O and teachers I have interviewed tell researchers that they had changed their teaching yet classroom observations of these very same teachers revealed familiar patterns of teaching? The answer depends on what each person means by “change” and who judges the worth of the change.

Change clearly meant one thing to teachers and another to researchers. Teachers had, indeed, made a cascade of incremental changes in their daily lessons. Researchers, however, keeping in mind what policymakers intended, looked for fundamental changes in teaching. In the case of Mrs. O—from memorizing math rules and getting the correct answer to focusing on conceptual understanding. Or in my case, getting teachers to shift from traditional to non-traditional instruction in seating arrangements, lesson activities, teacher-talk, use of projects, etc. In one instance, teachers saw substantial incremental “changes,” while researchers saw little fundamental “change.”

Whether those teachers’ incremental changes or the fundamental changes state policymakers sought led to test score gains, given the available evidence, no one yet knows.

So whose judgment about change matters most? “ Should researchers “consider changes in teachers’ work from the perspective of new policies….[or intentions of policymakers]? Or should they be considered from the teachers’ vantage point? (p.312).

Researchers, however, publish their studies and teachers like Mrs. O seldom tell their side of the story. Yet teachers’ perceptions of change have to be respected and voiced because they have indeed altered their practices incrementally and as any practitioners (lawyers, doctors, accountants) will tell you, that is very hard to do. How to honor teachers’ incremental changes while pointing out few shifts in fundamental patterns of teaching is the dilemma with which I have wrestled in researching high-tech use in schools.

____________________________

I now include a long comment to the above post from Brian Rude, a community college teacher. It was written on November 18, 2009

Larry, you sound frustrated. You are frustrated because teachers don’t do things quite the way you believe they should? So who’s right, you or the teachers?

I am no fan of B. F. Skinner, but he did say one thing that I think is very important. (At least I think it was Skinner. It was decades ago when I read this.) He said “The mouse is always right.” The context here is a psychologist doing an experiment with a mouse, and being frustrated because the results don’t come out as the psychologist would like and expect. It is quite understandable that the psychologist would blame the mouse, but it doesn’t take much reflection to realize how wrong that is. Of course the mouse doesn’t get it! It’s a mouse!

You say, “Policymaker decisions to buy and deploy high-tech devices was supposed to shift dominant ways of traditional teaching to student-centered, or progressive approaches.” Why on earth should it? Who’s right, the policy makers or the teachers? High tech is going to change the essential nature of teaching? Why should it?

I think my view is evident by now. If we want to learn about teaching and learning, we’d better look closely at what teachers and learners actually do, not what we think they should do. We need to ask why they do what they do, not why they don’t do what someone else thinks they should.

I teach lower level math courses in a community college. Every day I struggle with how to make students understand. I use high tech, everyday. I’m using high tech right now to write this. I’m not writing with a pencil or a fountain pen as I did in my youth. But that is pretty much irrelevant to the essential task of stringing words together in a way that will effectively communicate thoughts. Similarly the essential tasks of teaching have never changed. You need some way to present information. Students must attend to that information. They must build structures of knowledge in their minds. A lot of feedback is necessary for this to happen. My job is to provide them with the raw materials to build those structures of knowledge, and to guide them, as best I can, in how to build those structures of knowledge. Thus everyday I go to class and very carefully explain mathematical ideas and how to put them together. Everyday I do my best to put together well chosen problems for well designed homework assignments. Everyday I complain, at least to myself, about the bad textbooks we are stuck with. Every day, both in class and helping students individually in my office, I get questions that reveal misconceptions and errors of one sort or another in the thinking of students. I struggle to understand those misconceptions and errors of thinking, and to set the students on the right path again.

Almost everyday I make out handouts (usually pull them up from previous semesters and revise as needed) because that’s often the best way to make an assignment that meets my idea of what a good, effective, productive assignment should be. Well designed homework assignments are crucial, in my opinion. That’s where the rubber meets the road, so to speak. Math is a subject of ideas, but almost all math is learned by almost all students by doing problems. And they have to be the right problems, problems that provide the framework for students to put together mathematical ideas in ways that construct real knowledge. I am quite aware that many would dismiss me as a “worksheet teacher”. Who cares? I use high tech to make these handouts. But that is irrelevant to the essential nature of what I am doing. I am essentially doing the very same thing I did as a young teacher in the 60’s when I would make handouts on a spirit duplicating machine (and the kids would sniff them when they got them). All that high tech is no more central to the essence of teaching than is having a nice car to get me to work, rather than the 55 Chevy that took me to work in the early sixties.

I’m not claiming Mrs. O and the other teachers you describe are doing the best possible job in every situation. And I’m certainly not claiming that I do a perfect job in every situation. I am just saying that to be frustrated because they don’t do things the way you think they should, is to be like the psychologist who blames the mouse. The mouse just doesn’t get it. Of course. It’s a mouse. The teachers just don’t get it? Of course, they are teachers. They have reasons for what they do, though they may be no good at all in explaining those reasons, or even recognizing them. When there is a difference in what researchers and policy makers think is desirable, and what teachers actually do in the real world, I’ll go with the teachers every time.

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Toddlers and Touchscreens: What Does the Research Actually Say? (Marnie Kaplan)

“Prior to joining Bellwether, Marnie [Kaplan] worked as a policy analyst at Success Academy Charter Schools, where she analyzed local, state, and federal education policies. Previously she worked as a program manager at the District of Columbia Public Schools, where she tracked and analyzed special education compliance, and as a Stoneleigh Emerging Leaders Fellow at the Education Law Center, where she proposed solutions to reform Pennsylvania’s alternative education system and improve the accountability of cyber charter schools. Marnie began her career as a middle school English and social studies teacher in New York City. She went on to earn her M.P.P. and J.D. from Georgetown University. While in graduate school, Marnie interned at the Department of Education Office of Civil Rights, the Lawyers Committee for Civil Rights Under Law, and the DC Public Schools’ Urban Education Leaders Internship Program; taught street law to high school students; worked in a day care center; volunteered with 826DC; and served as a research assistant to the Georgetown Center on Poverty and Inequality. Marnie also holds a master’s in the science of teaching from Pace University and a bachelor’s degree from the University of Pennsylvania” (Bio taken from Bellwether staff descriptions)

This post appeared December 8, 2016 in Ahead of the Heard, A Bellwether blog.

 

 

 

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You walk by an outdoor restaurant and see a toddler watching a movie on an iPad while his parents eat dinner. Your first thought is:

  • a) those parents deserve a break
  • b) screens don’t belong at meal time
  • c) is the video educational?
  • d) alert: bad parenting

Is there an app to help us decide how to respond? No. But a quorum of pediatricians might be able to help.

From 1999 till 2016, the American Academy of Pediatrics (AAP) discouraged the use of screen media by children under two (which might have led an informed passerby to loosely circle answer d while feeling slightly judgmental). But just last month, the AAP departed from its previous strict restriction on screen exposure for this age group.

There was a lot of media attention heralding the departure from the “no screens under two rule.” Some celebrated the beginning of the end of the “screen wars.” In reality, while the new guidelines offer a more nuanced view of screen exposure, the debate will likely rage on. Screens continue to pervade modern life so rapidly that research can’t keep up.

Let me fill in some background on why the AAP changed its recommendations. The “no screens before two” rule was first issued in 1999 as a response to interactive videos for infants such as Baby Einstein. Research showed these videos decreased children’s executive functioning and cognitive development. In October 2011, the AAP reaffirmed its original statement regarding infants and toddlers and media. The AAP’s statement cited three reasons: a lack of evidence on children learning from television or video before age two, studies showing a link between the amount of TV that toddlers watch and later attention problems, and studies pointing to how parents and playtime are affected by always-on TV. Since this statement was developed through  a lengthy internal review process, it was drafted before the iPad was first introduced to the market in April of 2010. So for the last five years, the strict restriction on screen time included touch screens even though the committee hadn’t evaluated the emerging research on this media.

In the intervening years, many doctors and scientists urged the AAP committee on children and media to revisit their recommendations and take a more balanced approach to media. In 2014, Dr. Michael Rich, the director of the Center on Media and Child Health at Boston Children’s Hospital, urged experts to base their recommendations on evidence-based decision making instead of values or opinions. He criticized pediatricians for focusing too much on negative effects and overlooking the positive effects of media on children. Later that year, Dr. Dimitri Christikas, director of the Center for Child Health, Behavior, and Development at University of Washington, suggested rethinking the guidelines to distinguish between TV and interactive screens. Dr. Christikas was one of the first researchers to determine that the time babies and toddlers spend in front of the TV was detrimental to their health and development. He posited that the time young children spend interacting with touch screens is more analogous to time playing with blocks than time passively watching a television. In 2015, a trio of pediatricians published an article offering further support for the idea that interactive media necessitated different guidelines than television. In the same article, they recognizing the need for further research and argued that doctors should emphasize the benefits of parents and children using interactive media together.

So what are a quorum of pediatricians saying in 2016?

The new AAP guidelines still set rather strict restrictions for children under eighteen months. The AAP recommends that infants and toddlers only be exposed to screens for the purpose of video chatting with family members. This squares with some emerging observational research but likely also displays pediatricians’ understanding of modern life. The new AAP guidelines say parents can introduce children between 18 and 24 months to education shows. For children between the ages of two and five, the AAP recommends a max of one hour per day of “high-quality programs,” which they define as PBS and Sesame Network.

But there remains a lot that pediatricians, neuroscientists, and developmental psychologists cannot say conclusively. How does a small child clamoring to watch videos of herself affect a child’s conception of self?  Does the sensory experience of interactive screens have negative effects on small children’s brains?

Scientists continue to approach the research regarding long-term effects of this exposure from different perspectives. In fact, earlier this month, at the annual meeting of the Society of Neuroscience, new research was presented which hinted at the possible detrimental effects of touch screens on young brains. Dr. Jan Marino Ramirez, from the Center for Integrative Brain Research at the Seattle Children’s Research Institute, presented new research which revealed that excessive exposure to sensory stimulation early in life had significant effects on the behavior and brain circuits of mice. The mice acted like they had attention deficit disorder (ADD), showed signs of learning problems, and engaged in risky behavior. Ramirez therefore recommends minimizing screen time for young children. In a recent interview, Dr. Leah Krubitzer, an evolutionary neurobiologist at University of California, Davis, was less concerned about the detrimental impacts of screen time. She believes the benefits may outweigh the negative effects. Krubitzer argues that fast-moving interactive touch screens may prepare children for our increasingly fast-paced world.

So, parents of young children can now feel less guilty encouraging their toddlers to video chat with family across the country. And possibly we have a more clear answer for the scenario above (e.g., If the child is at least two years old, the appropriate response is c, at least for now).

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Testing in Medicine, Testing in Schools (Abigail Zuger, M.D.)

The following article appeared in the New York Times on April 13, 2015. I have often compared primary care physicians to teachers; sometimes the comparisons worked and sometimes they did not. This article looks at testing in both arenas, medicine and schooling.  Abigail Zuger compares school-based standardized tests and her work one day of spending five hours seeing 14 patients and ordering 299 diagnostic tests. Do you agree with the analogy she draws? Why?

I spent the usual long afternoon at work doing little but ordering tests, far more than I honestly thought any patient needed, but that’s what we do these days. Guidelines mandate tests, and patients expect them; abnormal tests mean medication, and medication means more tests.

My tally for the day: five hours, 14 reasonably healthy patients, 299 separate tests of body function or blood composition, three scans and a handful of referrals to specialists for yet more tests.

Teachers complain that primary education threatens to become a process of teaching to the test. They wince as the content of standardized tests increasingly drives their lesson plans, and the results of these tests define their accomplishments.

We share their pain: Doctoring to the tests is every bit as dispiriting.

Some medical tests, like blood pressure checks, are cheap and simple. Some are pricier and more complicated, like mammograms or assays for various molecules in the blood that correlate with various diseases. We order them all at prescribed intervals, and if we happen to forget one, either by accident or design, electronic medical records nag us mercilessly until we capitulate.

As in education, our test-ordering behavior and our patients’ results increasingly define our achievements, and in the near future our remuneration is likely to follow. Still, like all test-based quality control systems, ours can be gamed. Our tests can also inflict unnecessary psychic damage, and occasional physical damage as well.

Most distressing: Ordering tests, chasing down and interpreting results, and dealing with the endless cycle of repeat testing to confirm and clarify problems absorb pretty much all our time.

It is all in the name of good and equitable health care, a laudable goal. But if you reach age 50 and I cannot persuade you to undergo the colonoscopy or mammogram you really don’t want, am I a bad doctor? If you reach age 85 and I persuade you to take enough medication to normalize your blood pressure, am I a good one?

I am not the only one who wonders.

A cadre of test skeptics at Dartmouth Medical School specialize in critically examining our test-based approach to well adult care. If you are confused about mammography, colonoscopy or the PSA test for prostate cancer, these folks deserve much of the blame: They have repeatedly demonstrated that these tests and many others do not necessarily make healthy people any healthier, any more than standardized testing in grade school improves a child’s intellect.

Dr. H. Gilbert Welch, a Vermont physician who is part of the Dartmouth group, has a new book that might serve as the test skeptic’s manifesto and bible. Its title, “Less Medicine, More Health,” sums up his trenchant, point-by-point critique of test-based health care and quality control.

In medicine, “true quality is extremely hard to measure,” Dr. Welch writes. “What is easy to measure is whether doctors do things.” Only doing things like ordering tests generates data. Deciding not to do things and let well enough alone generates nothing tangible, no numbers or dollar amounts to measure or track over time.

Dr. Welch points out that doctors get to become doctors because they are good with tests, and know instinctively how to behave in a test-focused universe. Rate them by how many tests they order, and they will order in profusion, often more than the guidelines suggest.

They will do fine on assessments of their quality, but patients may not do so well. Even perfectly safe tests that are incapable of doing their own damage may, given enough weight, trigger catastrophe.

Yes, little blood pressure cuff over there in the corner, that means you. The link between very high blood pressure and disease is incontrovertible, and the drugs used to control blood pressure are among the cheapest and safest around.

Even so, as Dr. Welch pointed out in a recent conversation, systems that rate doctors by how well their patients’ blood pressure is managed are likely to invite trouble. Doctors rewarded for treating aggressively are likely to keep doing so even when the benefits begin to morph into harm.

That appears to happen in older adults, at least in those who avoid the common complications of high blood pressure and continue on medication. One study found that nursing home residents taking two or more effective blood pressure drugs did remarkably badly, withdeath rates more than twice that of their peers. In another, dementia patients taking blood pressure medication with optimal results nonetheless deteriorated mentally considerably faster.

Yet no quality control system that I know of gives a doctor an approving pat on the head for taking a fragile older patient off meds. Not yet, at least. Someday, perhaps, not ordering and not prescribing will mark quality care as surely as ordering and prescribing do today.

Children go to school to learn. Adults go to the doctor … why? If they are sick, to get better, certainly. But for the average healthy, happy adult, let’s be honest: We really haven’t completely figured out why you are in the waiting room. And so we offer a luxuriant profusion of tests.

 

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