In the December 10 issue of the New Yorker magazine Atul Gawande published a fascinating article about the improvement of medical practice. Although he is a physician writing about medical care, I found his insights to be surprisingly relevant to instructional issues in the field of reading.
In this article, “The Checklist,” Dr. Gawande describes the incredible complexity of Intensive Care Medicine, and the brilliance and courage of the doctors who practice it. But this was not a piece about heroic doctors, but instead explained the need to standardize and regiment such practice in order to maintain quality.
I know…. I know…. the sentences in the previous paragraph don’t seem to go together. If practice in intensive care units (ICU) is so complicated and important, and physicians are so brilliant and committed, then why would anyone want to regiment that practice? You may want to invest in more professional development or reduce case loads, but adding more rules, regulations, and checklists seemingly would undermine rather than support the delivery of high quality care. As a physician who Gawande quotes puts it: “‘Forget the paperwork. Take care of the patient.”
Gawande describes how “No Child Left Behind”-style efforts are now being used to script medical practice, and how resistant physicians are to these intrusions. The basal reader-like regimentation of medical practice “pushes against the traditional culture of medicine, with its central belief that in situations of high risk and complexity what you want is a kind of expert audacity.”
The field of reading shares that devotion to the idea of “expert audacity” in teaching. Think of every movie or television show that you have ever seen on teaching (The Great Debaters, Dead Poets Society, Blackboard Jungle, To Sir With Love, Mr. Holland’s Opus, and on and on and on). In all of those kinds of stories there is a teacher who against all odds takes on the system with no curriculum, no textbooks, nor colleague support, and makes a difference in the lives of students.
Good teaching these days is not that individual. Every teacher matters, but no teacher alone really makes the difference—especially in something complex like learning to read. We need teachers who will do a great job and raise literacy achievement and who will then turn these kids over to another teacher, who will also raise literacy achievement. That is more likely to be accomplished when everyone is doing the right thing.
The right thing in this case is complex, because there are many things that need to be learned about reading and these components all must be orchestrated into a powerful whole. Not teaching essential skills and strategies thoroughly enough that students can master them will do harm. Because of this, we need textbooks and systematically-organized curriculum to better support teacher efforts.
As Dr. Gawande writes: “It is ludicrous, though, not to suppose that checklists are going to do away with the need for courage, wits, and improvisation. The body is too intricate and individual for that: good medicine will not be able to dispense with expert audacity. Yet it should also be ready to accept the virtues of regimentation.” He concludes that because requiring doctors to carry out checklists of required procedures is being shown to make a big difference in patient's well being.
That makes sense to me. Teachers who work closely with their colleagues by adhering to the discipline of a shared systematic curriculum are not surrendering their professionalism. They are just better focusing their courage and intelligence on those aspects of practice where those qualities will help rather than hinder children. If lists and prescribed practices can improve medical care with all of its complexity, I certainly expect that it can do the same for reading teachers. Using a good textbook is not an act of surrender or submission.
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