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Getting Better: Lessons for Educators From a Surgeon

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This post is by Rick Lear, the executive director of Envision Learning Partners.

"What does it take to be good at something in which failure is so easy, so effortless?" That simple question lies at the heart of Better: A Surgeon's Notes on Performance, by Atul Gawande. Gawande has published a steady stream of increasingly successful ruminations on his profession over the past two decades.

He almost singlehandedly rescued checklists from the rubbish heap of discarded ideas in The Checklist Manifesto and, most recently, allows us a deeply personal look into his own life in Being Mortal. A beautiful writer and gifted storyteller, Gawande is also a superb educator.

Better, in fact, could been written for teachers. Underneath all our attention to deeper learning in our students lies this hard fact: significant increases in the nature and degree of student accomplishment will be driven largely by increasing the capacity of adults who have taken on the responsibility of helping students learn.

Early on in Better, Gawande writes, "The struggle to perform well is universal: each of us faces fatigue, limited resources, and imperfect abilities in whatever we do. But nowhere is this drive to do better more important than in medicine, where lives may be on the line with any decision."

The last sentence is unarguable, in the sense that education "deaths" take longer and, in fairness, are almost always metaphorical. But any of us who have watched students closely, as well as taught them, has seen possibility dim or hope flicker out in the eyes of students because of our individual and collective imperfections. Because we affect directly the lives of others, Gawande goes on to say, these imperfections are different than a shortstop's throwing error: "our decisions and omissions are...moral in nature."

Gawande has an answer, of course, to his essential question: three core requirements for success in medicine--or in any endeavor that involves risk and responsibility.

The first requirement is diligence, "the necessity of giving sufficient attention to detail to avoid error and prevail against obstacles. Diligence seems easy, and a minor virtue. (You just pay attention, right?) But it is neither. Diligence is both central to performance, and fiendishly hard...."

The second requirement is to do right--just that. Not so simple, Gawande says, in any effort that is a fundamentally human enterprise.

Ingenuity, Gawande's third requirement, "is not a matter of superior intelligence, but of character. It demands more than anything a willingness to recognize failure, to not paper over the cracks, and to change. It arises from deliberate, even obsessive, reflection on failure and a constant searching for new solutions. These are difficult traits to master, but far from impossible ones."

So, three things, each deceptively simple in a complex profession. Better describes how doctors embody these three requirements, or are sometimes confounded by their circumstances. Key among the confounding factors, and another link between medicine and education, is professional isolation. "Doctors are expected to coach themselves. We have no one but ourselves to lift us through the struggles. But we're not good at it."

As educators, we find ourselves in a similar situation. What, in fact, does diligence demand of us, singly and together? Out of the universe of things I might look at in my classroom, what do I pay attention to? What do we see when we look carefully, and what might we do about what we see? What am I not seeing about my own work that my colleagues might see? What do I need to change about my practice to do right by each student?

Over the past two decades, thousands of teachers have become part of critical friends groups or professional learning communities, or have engaged in formal lesson studies--sometimes, a combination of the three. The desire to improve runs deep among good teachers, and the process in ongoing.

Gawande is part of a larger movement in medicine known as improvement science, or improvement research, that is slowly gaining a foothold in education, due largely to the efforts of the Carnegie Foundation for the Improvement of Teaching. Improvement research differs from conventional education research in its focus on grass-roots, classroom-based investigation characterized by rapid iteration, careful data collection, and a focus on small, regular routines.

The hope is that multiple routines--easily shared and replicated--will standardize best practice, realize efficiencies, and allow teachers more time to use their energy and judgment on more critical aspects of teaching that are not subject to routine practice. What does Keisha need now? Why isn't that group working well together? What's the best way to know what those two can actually do? How did Terrence come up with that--what is the thinking?

Whether improvement science will transfer from medicine to education is an open question, far too early to answer. Will teachers have the bandwidth to take on one more thing that, at first blush, may feel daunting? Will teachers open their practice willingly to other teachers?

Whether that happens or not, Gawande reminds us that medicine, like teaching, carries with it a moral obligation to do well by our patients (or students). As he states:

"Betterment is perpetual labor. The world is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality. To complicate matters, we in medicine are also only human ourselves. We are distractible, weak, and given to our own concerns. Yet still, to live as a doctor is to live so that one's life is bound up in others' and in science and in the messy, complicated connection between the two. It is to live a life of responsibility. The question then, is not whether one accepts the responsibility. Just by doing this work, one has. The question is, having accepted the responsibility, how one does such work well." 


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