[EAS] Immodest Proposal for Excellence

Peter J. Kindlmann pjk at design.eng.yale.edu
Thu Oct 27 23:48:05 EDT 2005


Dear Colleagues -

This makes thought-provoking reading. It is about quality control in 
teaching, overtly here in a hospital setting, but by implication also 
in an engineering program or a company. It proposes an aggressive 
attitude, such as in the Johns Hopkins program (described below) 
which is an aggressive drive to lower to zero the infection rate in 
intensive care units. The protocols are stringent and are working.

>"Early on in this new routine, every nurse was handed two phone 
>numbers-the home phones of the medical school dean and the 
>university president-and told that if a physician didn't follow 
>protocol and refused to abort the procedure, they were to phone one 
>of these numbers, even at 3 a.m. That only happened once. The 
>infection rate at Johns Hopkins for that procedure is now 
>approaching zero."

The piece concludes by asking how much engineering education and 
student success in courses could be improved by similar methods?

>Faculty and teaching institutions face many impediments, just like 
>physicians; the conditions and capabilities of our students are 
>often unknown. But what if at some universities the president was 
>called every time a student failed? This proposal sounds crazy, I 
>know, but that's just the point. We're too comfortable with our 
>failures; we take them for granted. The good news is that we can do 
>much better. We know a great deal today about how to organize our 
>institutions and classrooms so that students not only stay but 
>achieve at high levels, and research in the cognitive sciences and 
>other fields provides grist for further improvements. I know we lack 
>the resources. I know we lack the administrative and policy support. 
>I know that some students we inherit are already deeply wounded. 
>Nevertheless, we need to ask much more of ourselves. Education is no 
>place for modest ambitions.

The author is the president of the Carnegie Foundation for the 
Advancement of Teaching.

     --PJK

----------------------------------------------------------------------------
>Date: Wed, 26 Oct 2005 14:48:51 -0700
>To: tomorrows-professor at lists.Stanford.EDU
>From: Rick Reis <reis at stanford.edu>
>Subject: TP Msg. #676 EXCELLENCE; AN IMMODEST PROPOSAL
>Sender: owner-tomorrows-professor at lists.Stanford.EDU
>
>"Early on in this new routine, every nurse was handed two phone 
>numbers-the home phones of the medical school dean and the 
>university president-and told that if a physician didn't follow 
>protocol and refused to abort the procedure, they were to phone one 
>of these numbers, even at 3 a.m. That only happened once. The 
>infection rate at Johns Hopkins for that procedure is now 
>approaching zero."
>
>		*	*	*	*	*	*
>		TOMORROW'S PROFESSOR(SM) MAILING LIST
>	         desk-top faculty development one hundred times a year
>
>			Over 25,000 subscribers!
>			Over 650 postings
>			Over 650 academic institutions
>			Over 100 countries
>
>			       Sponsored by
>        THE STANFORD UNIVERSITY CENTER FOR TEACHING AND LEARNING
>			http://ctl.stanford.edu
>
>            An archive of all past postings (with a two week delay) 
>can be found at:
>  		http://ctl.stanford.edu/Tomprof/index.shtml
>
>		*	*	*	*	*
>
>Folks:
>
>The posting below, by Lee Shulman, president of the Carnegie 
>Foundation for the Advancement of Teaching (CFAT) looks at important 
>lessons to be learned from some aspects of medical education.  It is 
>#20 in the monthly series called Carnegie Foundation Perspectives. 
>These short commentaries exploring various educational issues are 
>produced by the  CFAT<http://www.carnegiefoundation.org>.  The 
>Foundation invites your response at: 
>CarnegiePresident at carnegiefoundation.org. Reprinted with permission.
>
>Regards,
>
>Rick Reis
>reis at stanford.edu
>UP NEXT: Sharing in the Online Community
>
>			   Tomorrow's Teaching and Learning
>
>	--------------------------------------- 1,063 words 
>--------------------------------
>
>			EXCELLENCE; AN IMMODEST PROPOSAL
>
>September 2005
>By Lee S. Shulman
>
>Recently, I participated in a site visit to the teaching hospital of 
>a major American medical school. These visits are an integral part 
>of the Carnegie Foundation's ten-year program of research on how 
>lawyers, engineers, clergy, school teachers, nurses, and physicians 
>are taught and how they learn. On this visit, I joined a team of 
>students and faculty in the daily ritual of clinical rounds.
>
>I use the term "ritual" quite precisely: the clinical-rounds team 
>follows the same pedagogical pattern daily as it moves from patient 
>to patient and reviews the status of each. The team I observed 
>included a chief resident, a third-year resident, two first-year 
>residents, two third-year medical students beginning their internal 
>medicine rotation, and a pharmacy student on internship. Each of 
>seven patients comprised a "lesson" within a unit of instruction. We 
>stopped outside every room. The resident or medical student 
>responsible for that patient gave a report that followed a strict 
>outline. We talked about what had changed from the previous day. 
>Patients ranged from someone who had been in the intensive care unit 
>for less than twenty-four hours to one who had been in a coma for 
>thirty days. After thirty days of clinical investigation, the causes 
>of this patient's condition were still unknown.
>
>Next, the chief resident discussed what had occurred during the 
>rounds with the third-year resident in a preceptor interaction, 
>essentially like a supervising teacher with a student teacher. They 
>reviewed how rounds had gone pedagogically and talked about what 
>other questions one might have asked, what other aspects of 
>patients' conditions one might have noted, and how well patients 
>were managed and whether to do something different. We then moved to 
>teaching rounds, in which the chief resident presented a didactic 
>seminar on pulmonary function tests.
>
>The day ended with "M&M" (Morbidity and Mortality), otherwise known 
>as, "Where Did We Screw Up and What Can We Learn from It?" Pretty 
>much the same group from morning rounds reconvened, joined by other 
>faculty. Their goal was quality assurance. They reviewed at an 
>institutional level one of their most persistent failures, namely 
>the unacceptably high infection rate in the intensive care unit, 
>primarily associated with running central lines into arteries (a 
>procedure some readers will know in detail from Atul Gawande's 
>wonderful book about the training of surgeons, Complications: A 
>Surgeon's Notes on an Imperfect Science.) Data indicated that the 
>infection rate is higher under certain circumstances, lower under 
>others. Everyone in the system was learning. In fact, an assistant 
>professor ran the session, with full professors learning alongside 
>third-year clerks.
>
>This kind of communal questioning and learning is compelling. Where 
>in higher education more generally do we find an institutional 
>pressure to come together and ask why students are not learning 
>mathematics or economics well, and what to do institutionally about 
>that? What I watched at this teaching hospital was an institution 
>actively investigating the quality of its work, knowing, caring, and 
>operating corporately to improve and learn from its collective 
>experience. This is an important model for the rest of higher 
>education. But it was a model not only of a powerful pedagogical 
>process but of something else-something we see far too seldom in 
>education.
>
>During the last part of this Morbidity and Mortality conference, the 
>facilitator noted that every major hospital has a problem with high 
>infection rates in ICU's associated with running central lines, 
>especially in the femoral artery. Unfortunately, it's easiest for 
>medical practitioners to run a line in the femoral artery. (Perhaps 
>running femoral lines is analogous to running lecture courses; 
>they're not necessarily the most effective, but they deliver the 
>goods to the largest number at the lowest cost.) In any case, the 
>facilitator mentioned that Johns Hopkins had decided that the high 
>infection rates were unacceptable. The medical school dean and the 
>university president met with the teaching hospital staff and 
>decided they knew enough to approach a zero percent rate of 
>infection. The problem was not absence of knowledge of best 
>practice, but absence of discipline and commitment to apply that 
>knowledge. Therefore, they developed a rigorous protocol for running 
>central lines.
>
>The protocol involves things such as how carefully and frequently 
>hands are washed, and not making things easier on oneself by using 
>the same line to draw blood and to deliver medication because the 
>odds for an infection zoom up every time that happens. Nurses 
>enforce the protocol and oversee each procedure, and nurses are 
>empowered to abort a procedure as soon as they see protocol being 
>violated, whether by an intern or by the department chair. Early on 
>in this new routine, every nurse was handed two phone numbers-the 
>home phones of the medical school dean and the university 
>president-and told that if a physician didn't follow protocol and 
>refused to abort the procedure, they were to phone one of these 
>numbers, even at 3 a.m. That only happened once. The infection rate 
>at Johns Hopkins for that procedure is now approaching zero.
>
>Like infection rates, the failures of education are often 
>procedural. In the M&M conference, the discussion of acceptable 
>levels of infection sounded like arguments about acceptable levels 
>of student failure. If one-third of students drop out in the first 
>year, some may be ready to claim that those students simply 
>shouldn't have entered college. What if a hospital said that if it 
>lost a third of its patients, those patients never should have been 
>admitted because they were too sick? Faculty and teaching 
>institutions face many impediments, just like physicians; the 
>conditions and capabilities of our students are often unknown. But 
>what if at some universities the president was called every time a 
>student failed? This proposal sounds crazy, I know, but that's just 
>the point. We're too comfortable with our failures; we take them for 
>granted. The good news is that we can do much better. We know a 
>great deal today about how to organize our institutions and 
>classrooms so that students not only stay but achieve at high 
>levels, and research in the cognitive sciences and other fields 
>provides grist for further improvements. I know we lack the 
>resources. I know we lack the administrative and policy support. I 
>know that some students we inherit are already deeply wounded. 
>Nevertheless, we need to ask much more of ourselves. Education is no 
>place for modest ambitions.
>
>Carnegie Perspectives is a series of commentaries that explore 
>different ways to think about educational issues. These pieces are 
>presented with the hope that they contribute to the conversation. 
>You can respond directly to the author at 
>CarnegiePresident at carnegiefoundation.org or you can join a public 
>discussion at Carnegie Conversations.
>
>Join the Carnegie Perspectives email list by sending an email to 
>CarnegiePresident at carnegiefoundation.org with "Subscribe" as the 
>subject line.
>
>*	*	*	*	*	*	*	*
>NOTE: Anyone can SUBSCRIBE to the Tomorrows-Professor Mailing List by
>addressing an e-mail message to:
><Majordomo at lists.stanford.edu>
>
>Do NOT put anything in the SUBJECT line but in the body of the message  type:
>
>			subscribe tomorrows-professor
>*	*	*	*	*	*	*	*
>To UNSUBSCRIBE to the Tomorrows-Professor send the following e-mail
>message
>to: <Majordomo at lists.stanford.edu>
>
>unsubscribe tomorrows-professor
>-++**==--++**==--++**==--++**==--++**==--++**==--++**==
>This message was posted through the Stanford campus mailing list
>server.  If you wish to unsubscribe from this mailing list, send the
>message body of "unsubscribe tomorrows-professor" to 
>majordomo at lists.stanford.edu

-- 



More information about the EAS-INFO mailing list