Tuesday, July 30, 2013

Atul Gawande's recent article is relevant to education, too!

There is an excellent Atul Gawande piece in the New Yorker this week about improving medical practice.  There are two main ideas in the article, both of which apply beautifully to education:

1) consistent execution of simple, straightforward ideas is more important than fancy new technology
2) to achieve consistent execution of simple, straightforward ideas we should use one-to-one coaching--in Gawande's words, "people talking to people."

Every teacher and education wonk in the country should read Gawande's whole article, which is, like his other work (checklists! standardizing good practices!), clever, important, and very readable.

Consistent execution of simple, straightforward ideas
A lot of us teachers--me included--worry a lot about what the right curriculum is, think a lot about the big picture of lesson planning, argue about, say, whether kids should be assigned reading or should pick it themselves, and spend hours and hours on new technologies.  These are important things to worry about, and we should certainly be figuring out what matters for our students' learning, but what is probably much more important is our consistent and effective execution of what we already know matters.

Gawande's article begins by contrasting the immediate adoption of anaesthetic use during surgery with the many decades it took for antiseptic measures to take hold, even though the antiseptic measures were known to be hugely important and could have saved many, many lives.  One reason for the quicker adoption of anaesthetics is obvious: anaesthetic, unlike antiseptic measures, has very immediate and direct benefits that are obvious during surgery.  Surgery is painful and difficult without anaesthetics, and it's pretty easy with them.  Easy, but not necessarily effective.  To be effective, the surgery has to be antiseptic--the doctor has to wash his hands and instruments, has to wear freshly cleaned/sterilized clothing and mask, and has to soak up the blood and fluids with fresh gauze instead of the sea sponges that doctors used to use over and over, never sterilizing them. According to Gawande, these antispetic measures didn't catch on not only because they didn't have immediately observable benefits in combatting a visible and obvious problem, but because while anaesthesia made life a lot easier for doctors (imagine cutting into someone who's screaming and writhing in pain), the antiseptic measures actually made life considerably harder for them (Gawande describes early aseptic surgery as requiring surgeons "to work in a shower of carbolic acid").

This distinction between what is easy for the patient and what is easy for the doctor has its analogy in education.  Often, what is good for the student is not particularly easy for the teacher.  And often what comes naturally to the teacher is not what is best for the student.  It's hard for teachers to see this, and we need people to help us.  And even when we know what's important, we don't always manage to do it.  Again, we need people to help us. But what we need is not what we get.

One-to-one Coaching, not evaluation
If we know what teachers must do, but they (we!) don't always do it, how can we help them (us!) improve? In education, too often the only feedback teachers get is through an annual evaluation by a supervisor. These evaluations can be helpful, but we need much, much more.

I have a really great department chair.  She is thoughtful, hard-working, funny and wise, and she has gotten better and better at her job over the past eight years. I always learn a lot from my biannual evaluation.  But it is not nearly enough. I was evaluated this year, and Mary came to my class three times for a total of about an hour.  An hour every two years is just not enough observation. It's great, but it's not enough.

The other problem with our current scheme is that it combines coaching with evaluation. Having any observer in the room will probably change your teaching in some way, but having an observer who is going to be writing a report that goes into your personnel file and could theoretically be used to fire you is definitely going to change the teacher's practice--and the conversations afterward cannot possibly be as free and open with a supervisor as they might be with someone who was only a personal coach. The obvious answer is to have peer coaches who would not judge or evaluate, but only help.  This is essentially what Gawande describes in his article, and it is the obvious way forward for improving teaching--a much more humane and effective alternative to the methods pushed by ed reformers.

This is what teachers' unions should be working on. Instead of abolishing teacher tenure, peer coaching. Instead of a revamped evaluation system, peer coaching. Instead of VAM evaluations, peer coaching. Unions should be leading the way in designing non-punitive teacher-improvement programs.   Of course this is happening to some extent (for instance, one of the wise consultants Leafstrewn has had helping with its work on reading in the content areas is, I think, an expert in peer coaching), but we need much, much more of it. 

How it would work
A peer coaching system would take time. I've done some observing of other teachers, and I've been observed by my colleagues, and the problems have always been twofold: (1) the observations aren't targeted enough; (2) the observations and conversations haven't continued long enough for a comfortable working relationship to develop and for problems to surface, be discussed, and be worked out. Gawande's article addresses both of these problems.

Gawande describes programs that are aimed at specific issues: teaching cholera patientsto treat   themselves with a simple rehydrating solution (a treatment that is actually more effective than the intravenous rehydration that, though the high-tech standard, is impracticable in many places); and teaching obstetric nurses to make sure to execute the couple of dozen practices most important for the health of the mother and child (washing hands, encouraging skin-to-skin contact, monitoring the baby's temperature, etc.), practices that if followed could save millions of lives each year. These programs are staffed by coaches who, though trained, are neither powerful nor very experienced, and the coaching is not compulsory (the nurses don't have to take the advice if they don't think it's helpful). The key is the personal relationship and trust that develops over time.

Gawande describes a young nurse who observes and coaches an older, more experienced obstetric nurse.  After many visits, the older nurse started to change her practice. Gawande asks the older nurse why she listened to the younger, less experienced one; in the beginning, the older nurse said, she didn't.

"The first day she came, I felt the workload on my head was increasing." From the second time, however, the nurse began feeling better about the visits. She even began looking forward to them.
    "Why," I asked.
     All the nurse ccould think to say was "She was nice."
     "She was nice?"
     "She smiled a lot."
     "That was it?"
     "It wasn't like talking to someone who was trying to find mistakes," she said. "It was like talking to a friend."

We need to observe each other more, and not just for one or two times, but repeatedly over long periods, and like these nurses, we need to focus on the basics. I don't think teaching is quite as amenable as doctoring to standardization (for schools to use The Cheesecake Factory as a model, as Gawande wants hospitals to do, would be a mistake), but some questions are relevant for all English classrooms: what is the ratio of teacher talk to student talk? how much are the students reading? who is paying attention and who is not? where are the questions and ideas coming from? are our instructions clear? how much time are we spending/wasting on transitions and instructions? 

Teachers can certainly work on these basic issues on their own, and some of these questions are amenable to checklists or in-class assessments, but the same is true of the fundamentals of obstetric nursing. As Gawande's article shows, and as I know from long experience, just because we know what we should do doesn't mean that we actually do it. To learn to break our bad habits we need lots of sympathetic, non-judgmental help--and not just in the office around lesson-planning, but in the classroom, around execution. So when the current wave off top-down, authoritarian ed reform finally subsides, I hope we will see a boom in peer-to-peer coaching.

In any case, I recommend the whole Gawande article.


  1. Good old "Critical Friends Groups" from CES et al and Lesson Study a la Japan are perfectly good models (if often not perfectly implemented, ofc).

  2. Well, the CFG's I've been in have involved zero in-class observation. In fact, I've done more than a dozen professional development programs involving peer collaboration of one kind or another, and only two of them had any in-class observing--and in that one I had an experienced teacher as a mentor and was too terrified to actually ever let her observe me, so even that one didn't end up having an observation component in my particular case! The other program was supposed to have some observation, but it wasn't our main focus, so we ended up only doing it once for about twenty minutes. So in my ten-plus years of experience peer observations of the kind Gawande is describing pretty much never happen. Therre are no doubt good models out there, but we aren't using them much.