Recently, while we were having breakfast and discussing education research with the editor of this newsletter, Denis Doyle, he suggested that we read the book Complications by Atul Gawande. His suggestion was all the more relevant given the recent reauthorization of OERI, now the Institute of Education Sciences. In the book, Gawande discusses medicine through the eyes of a surgeon and reminds the reader that science is “ambiguous, information is limited, the stakes are high, yet decisions must be made.” Educators are now hearing more from key leaders at the U.S. Department of Education and national policymakers about the medical model that calls for using scientifically based research and evidence-based education. To be certain, education research needs strengthening, and educators need to use and have access to practices and materials that have demonstrated success. Current leaders are promoting an agenda that could lead to improving the quality of teaching and student achievement in direct response to the poor performance of U.S. students on national and international assessments. There is, however, a compelling and comparable message in what Gawande has to say about medical science that educators should consider. Just as scientific research alone is not the answer to all medical ills, scientific research alone will not solve all the problems contributing to the unacceptably low achievement of many American students. The research will, however, create a strong basis for continuous growth and evaluation.

In the book Achieving World Class Schools: Using a Genetic Model for School Improvement (coauthored by one of the writers of this essay), the authors discuss an example of how the medical model could be applied to education.  Many years ago, cataract surgery involved cutting of the eye and a long period of immobilizing the patient during recovery. Today, a cataract patient goes into the hospital early in the morning and under normal conditions is released several hours later. There are countless other examples with similar results in medicine. Simply stated, the knowledge of the medical profession continues to grow, and the results get much better. Why hasn’t education systematized methods to improve teaching and learning to build a body of professional knowledge that is routinely used in practice? Certainly there is ample research, good research in fact, on how people learn, how to effectively teach reading and mathematics, what is needed for substantive professional development plans, and effective instructional strategies.

In his book, Gawande alerts readers to the fact that medicine is not an exact science. Doctors use different medicines to treat diseases based on their professional knowledge and expertise. Their treatments don’t always work, and sometimes there are less-than-desirable consequences. Is this any different conceptually from teachers using a variety of instructional strategies that in some instances don’t work for some students? The real question should be whether or not those teachers use strategies founded in credible, research-based studies; whether or not the teachers possess sufficient content knowledge and understand pedagogy deeply enough; and whether the teachers routinely collect the right kinds of data about their practices to be able to make critical instructional decisions based on the belief that all children can learn and must have equitable opportunities to learn. Using what can be gleaned from Gawande’s book, we suggest that the difference between medicine and education is this: Even when good doctors don’t obtain their intended results, their decisions can be traced to credible research and practice. And, they understand the accountability and responsibility associated with their decisions. That, too, should be the underpinning for education practices in classrooms, schools, districts, and states.

Gawande explains that, in medicine there is a practice known as morbidity and mortality conferences. The sessions are private and not subject to litigation.  During the sessions, peers question their colleagues’ work that resulted in patient deaths or procedural mistakes. The questioning can become uncomfortable, but much can be learned from this type of intense peer review. Perhaps providing a secure environment for teachers and principals to discuss those aspects of their work that are not successful would lead to greater levels of educational improvement. More often than not, teachers and principals are relegated to careers of isolation and not given ample opportunities for serious reflection on their work. They are not provided the necessary time to learn what research supports and what successful, experienced colleagues practice.

Finally, surgeons are subjected to meticulous, intense training. They go through a rigorous residency, share their experiences with colleagues, and observe actual and videotaped surgery to better understand techniques and practices that work. The same experiential opportunities built on research-based practices in education would arguably lead to better trained teachers and administrators. What tends to be lacking in education are effective clinical preservice opportunities using simulations and video to enable future and practicing teachers to refine their skills and build content knowledge in a “virtual” environment. With the pending release of the Third International Mathematics and Science Study¯Repeat (TIMSS-R) video study—a video analysis of mathematics and science teaching from a number of countries—new opportunities to observe teaching from a research-based analysis of instructional practices around the world will soon be available. The challenge will be moving those findings to the field.

Clearly, there is much to be learned from the medical model that can be applied to education. Gawande does, however, shed light on the fact that medicine is not a perfect science, encounters unexpected results, sometimes fails, and has multiple strategies for solving the same problem. This same understanding of educational practice might help teachers build a professional body of knowledge to increase the chances that all of their students will be successful learners.

The No Child Left Behind (NCLB) Act mentions scientifically based research approximately 110 times. Educators have been advised that funding requests will be contingent on evidence-based practices and materials. While this may be a culture shift for the education profession, Gawande’s realistic discussion on the value of an informed profession, and the reality that it is not perfect, provides a sound basis for educators to begin the 12-year NCLB journey to ensure that every child successfully achieves proficiency in his or her state.

To support NCLB’s research-based underpinnings, the new Institute of Education Sciences is in the process of developing the What Works Clearinghouse. To be certain, the complexities of education in a country with a decentralized education system comprising nearly 15,000 locally controlled school districts can’t be reduced to a simple process of “surfing” the Web. But the clearinghouse promises to be more than a Web site and is expected to offer guidance and resources to support sound, research-based decision making and instructional practice.

While the No Child Left Behind Act and the new Institute of Education Sciences may not be “perfect,” they can contribute to improving the quality of education in ways that have not been previously attained in this country. Educators are now challenged with the reality of using scientifically based research, evidence-based practices, and meaningful data to ultimately conduct their practice in ways similar to the medical profession.

Gina Burkhardt
CEO and Executive Director
North Central Regional Educational Laboratory

Paul Kimmelman
Special Advisor to the Executive Director
North Central Regional Educational Laboratory

1/05/2003
Issue 3.2

To learn more about the authors please visit:

http://www.christopher-gordon.com/Authors/kimmelman.htm, visited January 13, 2003.
See also http://www.amazon.com
See also http://www.ncrel.org/