Schools That Integrate Technology: Silicon Valley

As complex as it is for an individual teacher to integrate daily use of high-tech devices into routine classroom practices, technology integration at a school level is even more complex. A classroom teacher with 25-35 students can alter the structures of her classroom and create a culture of learning, achievement and mutual respect. Hard as that is, it is do-able. I and many others have profiled teachers who have created such classrooms.

Imagine, however, schools with 30 to 100 classrooms and getting all of those teachers to work together to create school-wide infrastructure and a learning, achieving, and respectful culture–across scores of classrooms that seamlessly integrates computers to achieve the school-site’s goals. A complex task with many moving parts that is fragile yet strong. It does happen but remains uncommon.

I have observed a few schools in Silicon Valley that have integrated new technologies across the entire school requiring teachers to teach lessons using particular hardware and software. These schools vary from one another but tout that they “personalize learning,” blend instruction, and differentiate their lessons to meet differences among students. Invariably, they say they use project-based instruction.  They have created both an infrastructure and culture that subordinates technology to the larger tasks of preparing children and youth to do well academically and socially, graduate, and enter college (and complete it) or enter a career directly.

Considering what I have observed in Silicon Valley, documented nationally in my studies, and retrieved from the research literature on such schools elsewhere in the U.S., what are the common features of such schools?

Here are eight different yet interacting moving parts that I believe has to go into any reform aimed at creating a high-achieving school using technology to prepare children and youth to enter a career or complete college (or both). Note, please, that what I have garnered from direct observation, interviews, and the literature is not a recipe that can be easily cooked and served. Listing features I have  identified is not an invitation to insert some or all of these into a formula for producing such schools near and far. These schools are rooted in their contexts and context matters.

These features are:

*Recruit and train teachers who have the subject matter knowledge and skills to work with students  before, during, and after the school day.

*Recruit and train school site leaders who have the expertise and skills to lead a school and be a pillow and sandpaper simultaneously with teachers, students, and parents.

*Students have access to non-academic subjects that cultivate the mind, heart, and sensibilities.

*Equip all students with the knowledge and skills not only to enter college,  persist through four years and get a bachelor’s degree but also have the wherewithal to enter a career immediately.

*Organize the school day, week, and month that provides students with sufficient time in and out of class to learn the prescribed material and core cognitive skills to master a subject, acquire the essential skills of planning and assessing their progress in each course they take, receive tutorial help when student skill levels are below and above par, and time for students to receive mentoring from teachers they trust.

*Build a culture of safety, learning, respect, and collaboration for both youth and adults.

*Create a decision-making process that is inclusive, self-critical, and strong enough to make further changes in all of the above.

*Do all of this efficiently within available resources.

Note the absence of new technologies in the features that I have listed. Why is that?

Simply because such schools containing these features have administrators and teacher who figure out when to use software to achieve desired outcomes, create an infrastructure to support staff in using new technologies, determine which new technologies efficiently advance students in reaching these goals, and create the conditions for easy, supported use of the hardware and software. Note, then, that computers and their software are subordinate to the overarching goals for students and adults in the school.

Summit schools, a charter network in Northern California, has been working and re-working a design containing these moving parts for nearly 15 years. Over that period, they have amended, deleted, and added program features as administrators and faculty learned what worked and what didn’t. The time span, the stability in staff, their awareness of context and shifting demographics all came into play as Summit leaders and faculty figured out what to do since 2003.

Over the past two months I have visited two of Summit’s seven charter schools in the Bay area and in those two schools have watched teachers across different academic subjects teach 90-minute lessons during what the schools call “project time.” I have also interviewed administrators.  Each school was part of a different district in Silicon Valley. While one of the schools had a separate building in its district well suited to its mission, scheduling, and space for students, the other school was located on a high school campus in another district where both students and teachers worked in a series of portable classrooms. Also each drew from different populations.*

The network of Summit charter schools has been written about often and positively (see here, here, here, and here). In all instances, these teachers I observed had integrated the software they had loaded onto students’ Chromebooks, the playlists of videos and links to articles for units that teachers created, and students’ self-assessment exercises into daily lessons with varying degrees of student engagement. The charter network claims that through their Personalized Learning Plan (also see here) teachers could give each student individual help while students negotiated their ways through academic content and skills. In the two schools, I observed students during 90-minute classes in different academic subjects working on teacher-chosen projects. Students were using their Chromebooks frequently to access PLP voluntarily and at teachers’ direction.

The cliched statement said over and over again by advocates of new technologies in schools: “It is not about technology, it is about learning,” captured what I saw. Overall aims for Summit students to acquire academic content, cognitive skills, “habits of success,” and the know-how allowing students to assess their own progress involved online work  before, during and after lessons. Clearly, the school did not have to use Chromebooks and extensive software to reach the schools’ overall goals and each student’s personal ones. The technology did enable, however, the process of learning to be more efficient, more timely, and  give real-time feedback to students.

The two Summit schools in very different contexts contained these features I listed above. While differences existed between the two schools in context and staffing, both have implemented these features as best they could. Creating and massaging these many features of the Summit Schools is no easy task. It is not done once; it is a process that is constantly monitored, assessed, and altered by site leaders and staff.  Thus, listing the essential features that mark such enterprises is not a blueprint for action; it is an after-the-fact synthesis of what I saw and not easily replicable for those who have dreams of “going to scale.” It is what emerged from such efforts over a long period of time and requires tender, loving care every day. The program is fragile and easily broken by inattention, changes in leadership and staff, and declining resources. May it continue to thrive.

___________________________

*Diane Tavenner, a founding teacher at Summit Prep and director of Summit Schools Network and Chief Academic Officer, Adam Carter–also a founding teacher at Summit Prep–picked the two schools. In both schools, I interviewed the principals (called Executive Directors), and they suggested various teachers I should visit. Because of scheduling difficulties, I could not see all of those recommended to me. So in both schools, I reached out to other teachers, introduced myself and asked them if I could observe their classes.  The nine teachers who permitted me to spend a 90-minute block with them taught English, social studies, science, and math. For readers who wish to see my published observations, see posts for March 13, 2016, March 16, March 21, March 23, March 29, April 1, April 6, April 12, April 18.

 

 

 

 

 

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Using Computers To Transform Teaching and Learning: The Flight of a Butterfly Or a Bullet?*

As regular readers of this blog know, I have embarked on another project examining “best cases” of teachers, schools, and districts integrating computers into daily activities.  After four months of classroom observations, interviews with teachers and principals, and much reading I have begun to think of this project as a possible book. Much remains to be done, however, before it becomes one. In the fall, I will visit more classrooms and schools to do observations and interviews. I will do more reading of national surveys, case studies, and rigorous inquiries into what teachers and students do with devices. But the makings of a book are there in my mind.

So here is part of a proposal that I have sent to a publisher to see if they are interested. Subsequent posts will elaborate on other parts of this book proposal.

Overview and Rationale for Proposed Book

For over 30 years, I have examined the adoption and use of computers in schools (Teachers and Machines, 1986; Oversold and Underused, 2001, Inside the Black Box, 2013). I looked at the policy hype and over-promising accompanying new technologies in each decade. The question I asked was: what happens in schools and classrooms after the school board and superintendent adopt a policy of buying and deploying new technologies to improve schooling? This is the central question for any reform-minded policymaker, entrepreneur, parent, and practitioner because if teaching practices fail to change in the desired direction embedded in the policy then the chances of any changes in student performance are diminished considerably. Thus, in pursuing the issue of changes in classroom lessons in books, articles, and my blog, I moved back and forth between adopted policies for using computers, their classroom implementation, and shifts in teaching practices.

I described and analyzed computers in schools and classrooms across the U.S. including the highly touted Silicon Valley in the San Francisco Bay area. I tracked how these advocates and donors were often disappointed in how little school and classroom practice changed, anemic results in student achievement, and uncertainties in getting the right jobs after graduation, given the claims accompanying these devices and software.

There have been, however, occasional bright spots in individual teachers thoroughly integrating laptops and tablets into their practice and moving from teacher- to student-centered classrooms. And there were scattered instances of schools and districts adopting technologies wholesale and slowly altering cultures and structures to improve how teachers teach and students learn. I documented those occasional exemplars but such instances of classroom, school, and district integration were isolated and infrequent.

What slowly became clear to me over the years of studying the use of computers to improve how teachers teach and students learn and attain the overall purposes of public schooling is that policymakers have avoided asking basic questions accompanying any policy intended to reshape classroom practice. I concluded that those questions and their answers are crucial in understanding the role that computers in schools perform when it comes to teaching and learning.

This conclusion is behind my writing this book.

Reform-driven policymakers, entrepreneurs, researchers, practitioners, and parents have sought substantial changes over the past three decades in classrooms, schools, and districts to transform schooling while improving student outcomes. Yet, too often, they either avoided the inevitable steps that need to occur for such changes to materialize in schools or hastily leap-frogged over important ones. Four simple questions capture the essential steps in going from adopted policy to classroom practice.

  1. Did policies aimed at improving student performance get fully, moderately, or partially implemented?
  2. When implemented fully, did they change the content and practice of teaching?
  3. Did changed classroom practices account for what students learned?
  4. Did what students learn meet the intended policy goals?

These questions apply to innovations aimed at improving student academic performance such as creating small high schools and launching charter schools to states and districts adopting Common Core standards, competency-based learning and project-based teaching. Most importantly for this book, these questions pertain to making new technologies from laptops to hand-held devices not only accessible to every student but also expecting teachers to regularly use computers in lessons.

The questions emphasize the critical first step of actually implementing the adopted policy. Policies are not self-implementing. They require resources, technical assistance, staff development, and administrators and teacher to work together. This is especially so for teachers who are gatekeepers determining what enters the classroom door.

So without full or moderate implementation of a policy aimed at improving student performance, there is not much sense in pursuing answers to the other questions. Evidence of putting the policy into classroom practice is essential to determining the degree to which a policy is effective (or ineffective).

Once evidence of a policy’s implementation in schools and classrooms is available then the question of whether teaching practices have changed arises. This question gets at the nexus between teaching and learning that has been taken for granted in U.S. schools since the introduction of tax-supported public education nearly two centuries ago: Change teaching and then student learning will change. This is (and has been) the taken-for-granted belief driving reformers for the past century. Determining the degree to which teaching practices have changed in the desired direction and which have remained stable is essential.

The third question closes this circle of teaching producing learning by getting at what students have actually learned as a consequence of altered teaching practices. In the past half-century, policymakers have adopted measures of desired student outcomes (e.g., test scores, graduation rates, attendance, engagement in lessons). They assume that these measures capture what students have, indeed, learned. If teaching practices have changed in the desired direction, then changes in student outcomes (i.e., learning) can be attributed to those changes in classroom practices.

The final question returns to the immediate and long-term purposes of the adopted policy and asks for an evaluation of its intended and unintended outcomes. Immediate purposes might have concentrated on student test scores and graduation rates. Long-term purposes, the overall goals for tax-supported public schools, refer to job preparation, civic engagement, and producing independent and whole human beings.

These questions establish clear linkages between reform-driven policies and teaching practice. They steer this proposed book.

What if, however, policymakers, researchers, entrepreneurs, and parents looked not only at failed uses of classroom computers but also exemplary instances that have actually altered teaching practices to achieve policy ends? Examining how such “best cases” happened and their stability (or lack of it) might unlock the crucial next step of assessing changes in teaching practices and student outcomes.

_______________________________________________________

*The sub-title is a quote used by Philip Jackson, Life in Classrooms (1968), pp. 166-167.

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How To Do Adaptive Learning Right (Keith Devlin and Randy Weiner)

Keith Devlin is (@profkeithdevlin) Co-founder & Chief Scientist at BrainQuake and a mathematician in the Stanford University Graduate School of Education. Randy Weiner (@randybw15) is Co-founder & CEO at BrainQuake, a former teacher, & Co-founder and former Chair of the Board at Urban Montessori Charter School in Oakland, CA.

This opinion piece appeared in EdSurge, June 30, 2016.

As one variant of the saying goes, if your strength is using a hammer, everything can look like a nail. Examples abound in attempts to use new technologies to enhance (if not “transform”, or even “disrupt”) education. Technologists who have built successful systems in other domains—and who frequently view education as just another market in which to apply their expertise—often doom their project to fail at the start, by adopting a narrow and outdated educational model.

Namely, they see education as the provision of facts, techniques, and procedures to be delivered and explained by instruction and then practiced to mastery. Their role, then, is to bring their technological prowess to bear to make this process more efficient. In most cases they can indeed achieve this. But optimizing a flawed model of education is not in the best interests of our students, and from a learning outcomes perspective may make things worse than they already are.

In the case of adaptive learning, education commentator Audrey Watters gave examples of how things can go badly wrong on her blog. “Serendipity and curiosity are such important elements in learning,” she asks. “Why would we engineer those out of our systems and schools?” More recently, Alfie Kohn provided another summary of the numerous reasons to be skeptical of education technology solutions.

Watters’ bleak future will only come to pass if the algorithms continue to be both naïvely developed and naïvely applied, and moreover, in the case of mathematics learning (the area we both work in) applied to the wrong kind of learning tasks. Almost all the personalized math learning software systems we have seen fall into this category. But there is another way—as our work, and a thorough review by a third-party research organization—has shown.

We both work in the edtech industry and have a background in education. One of us is a university mathematician who spent several years on the US Mathematical Sciences Education Board and is now based in Stanford University’s Graduate School of Education, the other an edtech veteran who is a former teacher and who co-founded Urban Montessori Charter School.

We are both very familiar with the common “production line” model of education, and recognize that it not only appeals to many (perhaps most) technologists, but in fact is a system that they themselves did well in. But collectively, the two of us have many years of experience that indicates just how badly that approach works for the vast majority of students.

Last year, with funding from the Department of Education’s Institute for Educational Sciences, our company, BrainQuake, spent six months designing, testing and developing an adaptive engine to supply players of our launch product, Wuzzit Trouble, with challenges matched to their current ability level. We were delighted when classroom studies conducted by WestEd showed that the adaptive engine worked as intended (i.e., kept students in their zone of proximal development), straight out of the gate.

We developed the game based on a number of key insights accumulated over many years of research by mathematics education professionals that should be applicable to all edtech developers—even those who are not building math tools.

Experience Over Knowledge

First, the most effective way to view K-8 education is not in terms of “content” to be covered, acquired, mastered (and regurgitated in an exam) but as an experience. This is particularly (but not exclusively) true for K-8 mathematics learning. Mathematics is primarily something you do, not something you know.

To be sure, there is quite a lot to know in mathematics—there are facts, rules, and established procedures. Imagine the skills expected of a physician. None of us, we are sure, would want to be treated by someone who had read all the medical textbooks and passed the written tests but had no experience diagnosing and treating patients. And indeed, no medical school teaches future physicians solely by instruction, as any doctor who has gone through the mandatory, long, grueling internship can attest.

In the case of math, the inappropriateness of the classical, instruction-practice-testing dominated model of education has been made particularly acute as a result of the significant advances made in the very technology field we are working in. (Advances we wholeheartedly applaud. Our beef is not with technology—we love algorithms, after all—but with applying it poorly.) In today’s world, all of us carry around in our pockets a device that can execute almost any mathematical procedure, much faster and with greater accuracy than any human. Your smartphone, with its access to the cloud (in particular, Wolfram Alpha), can solve pretty well any university mathematics exam question.

What that device cannot do, however, is take a real world mathematical problem and solve it. To do that, you need the human brain. In order to do that, the human brain has to acquire two things, in particular: a rich and powerful set of general metacognitive problem solving skills, and a more specific ability known as mathematical thinking (a component of which is known as number sense, a term that crops up a lot in the K-8 math education world, since the development of number sense is the first key step toward mathematical thinking).

Human Adaptivity

Another key insight that guided the design of our adaptive engine is that the main adaptivity is provided by the user. After all, the human being is the most adaptive cognitive system on the planet! With good product design, it is possible to leverage that adaptivity.

Most “adaptive” math algorithms will monitor a student’s progress to select the next problem algorithmically. But it is important that these puzzles allow for a wide range of of solutions and a spectrum of “right answers,” leaving the student or teacher in full control of how to move forward and what degree of success to accept. (Of course, such an approach is not possible if the digital learning experiences are of the traditional math problem type, where the problem focuses on one particular formula or method and there is a single answer, with “right” or “wrong” the only possible outcomes.)

Indeed, students still need to grasp the basic concepts of arithmetic, understand what the various rules mean, and know when and how the different procedures can be applied. But what they do not need is to be able to execute the various procedures efficiently in a paper-and-pencil fashion on real world data.

Today’s mathematical learning apps can—and should—focus on the valuable 21st century skills of holistic thinking and creative problem solving. The mastery of specific procedures should be skills that a student acquires automatically, “along the way,” in a meaningful context of working on a complex performance task—an outcome every one of us knows works from our own experience as adults.

Breaking the Symbol Barrier

Mastery of symbolic mathematics is a major goal of math education. But as has been shown by a great deal of research stretching back a quarter of a century, the symbolic representation is the most significant reason why most people have difficulty mastering K-8 grade level math—the all-important “basics.” Almost everyone can achieve a 98 percent success rate at K-8 math if it is presented in a natural-seeming fashion (for example, understanding and perhaps calculating stats at a baseball game), but their performance drops to a low 37 percent if presented with the same math problems expressed in textbook symbolic form.

Well-designed technologies that take advantage of some unique affordances of a computer or tablet can help obliterate this historical impediment to K-8 mathematics proficiency. Students should be able to explore problems on their own until they discover—for themselves—the solution. They don’t require instruction, and they don’t need anyone to evaluate their effort. Students should get instant feedback not in the form of “right” or “wrong,” but information about how their hypotheses varied from their actual experience and how they might revise their strategy accordingly.

An analogy we are particularly fond of is with learning to play a piano (or any other musical instrument). You may benefit greatly from a book, a human teacher, or even YouTube videos, but the bulk of the learning comes from sitting down at the keyboard and attempting to play.

What could be a better example of adaptive learning than that? Tune too easy? Try a harder piece. Too difficult? Back off and practice a bit more with easier ones, or break the harder one up into sections and master each one on its own at a slower pace, and then string them all together. The piano is not adapting. Rather, its design as an instrument makes it ideal for the learner to adapt.

A well-designed math tool should be an instrument on which you can learn mathematics, free from the Symbol Barrier. Now imagine we present a student with an orchestra of instruments.

We think this kind of approach is the future of adaptive learning in math and believe we, the edtech community, should choose to go beyond the “low hanging fruit” approaches to adaptive learning that the first movers adopted.

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The Bipolar Literature on Technology in U.S. Schools

Reform-minded researchers, techno-enthusiasts, and skeptics in the U.S. have created an immense, convoluted literature on the use and effectiveness of computers in classroom, schools, and districts. It is a literature that is bipolar.

At one end there is the fiercely manic accumulation of success stories of teachers and schools that use devices imaginatively and, according to some researchers, demonstrate small to moderate gains in test scores, increased student engagement, teacher satisfaction, and other desired outcomes (see here and here). These success stories, often teacher surveys and self-reports, clothed as scientific studies (see here and here) beat the drum directly or hum the tune just loud enough for others to hear that these new technologies, especially if they are student-centered (see here) and “personalize learning” (see here), are just short of magical in their engaging disengaged children and youth in learning.

At the other end is the depressing collection of studies that show disappointing results, even losses, in academic achievement and the lack of substantial change in teaching methods during and after use of the new technologies (see here and here). Included are tales told by upset teachers, irritated parents, and disillusioned school board members who authorized technological expenditures (see here, here, and here).

These two poles of manic and depressive research studies replicate the long-term struggle between factions of Progressives who vowed to reform public schools beginning in the early 20th century. The efficiency-driven, teacher-centered wing of these Progressives whipped the experiential, whole-child, student-centered wing then but these losers in the struggle have returned time and again to preach and teach the ideology they hold so dear. Each pole of this spectrum, then, recapitulates the century-old struggle but this time the slogans and phrases are embedded in the language of new technologies. “Project-based learning” and “personalized learning” have been appropriated by current reformers who, still seeking efficiency and productivity in teaching and learning have adopted the language of their historical opponents. Knowing this historical backdrop, however, does not create a middle to this continuum. And that is necessary.

Reducing modestly the bipolarity of this literature are individual and collective case studies (see here), carefully done ethnographies (see here), and meta-analyses of  research studies done over the past half-century to ascertain the effects (or lack thereof) of computers and software upon students and teachers (see here, here, and here).

Even with these meta-analyses, the overall literature oscillating between manic and depressive has yet to develop a midpoint. Inhabiting that midpoint in this bipolar distribution of computer studies would be rigorous (and longitudinal) studies of classrooms, schools, and districts that combine technology exemplars and failures; carefully done classroom and school analyses that go beyond teacher responses on questionnaires to show the pluses and minuses of “blended learning, “project based teaching,” and “personalized learning” (see here, here, and here).  Yet such studies are occasional, not common, entries into the research swamp of technology-in-schools.

So What?

What’s the big deal about a skewed distribution of research studies and non-scientific articles and books? Here are a few reasons.

  1. By making clear that the literature is bipolar, readers can be more discriminating and less promiscuous in assessing claims researchers make and picking and choosing which research studies meet minimum standards of acceptability (e.g., rigorous qualitative, random controlled trials; size and representativeness of samples; brief or extended time of study; sponsored or independent research studies).
  2. Without much of a middle to the spectrum, readers seeking accurate information about the use of computers in public schools, would end up sampling studies at either end of the bipolar continuum and would get a grossly inaccurate picture of computer use and its effects in U.S. schools.
  3. Being aware that the current pushing and shoving over the aims of the new technologies and how they are implemented in school mirror historic struggles among different wings of educational Progressives a century ago can give the current generation of reform-driven policymakers and practitioners  a broader perspective on the fractious rhetorical and policy choices both educators and non-educators face now.

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Cartoons: A Mix This Month

Over the past seven years, I have published monthly cartoons on various aspects of policy and practice, school reform, etc. This month, the cartoons are a mix of ones that tickled me over the year. Yeah, I know, these choices tilt toward life in a digital world. So be it. Enjoy!

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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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Filed under how teachers teach, school reform policies, technology use