Of Ignatian Educators and Harvard Medical Grads
April 17, 2013 § Leave a comment
With commencement season upon us, I’ve been revisiting some of my favorite commencement addresses over the past few years, one of which is Dr. Atul Gawande’s 2011 speech to Harvard Medical School. Gawande is one of my favorite non-fiction authors. I read his book Complications prior to my senior year in college, and it was one of the books that opened my interest in healthcare ethics. It was also surprisingly compelling. His tales of the education of doctors — the encounters with patients, the trial and error, the dangers and the excitements — was the stuff of television.
In addition to his medical practice, Gawande writes often for The New Yorker. He’s one of those professional-scholar-writers that leave me in awe at their multidimensionality, at their ability to do so many different things so often and so well.
I read his 2011 address now as an educator, someone who is ceaselessly in discussions about reform, improvements, and novel ways of doing things. In education, it’s hard to catch one’s breath, settle down and say, “Okay, we can rest easy for a while.” The next upgrade, the latest research, is always knocking at the door. Teachers and administrators are constantly adapting or responding to advancements in society and to (supposed) upgrades in the field.
Gawande’s Harvard address reminds me that education is not alone in feeling this frantic pace and the call to innovation. Healthcare, too, and the profession of medicine are also constantly undergoing change. Doctors, too, have to navigate constant calls for reform in how medicine is practiced, delivered, and billed for. Gawande noted:
We are at a cusp point in medical generations. The doctors of former generations lament what medicine has become. If they could start over, the surveys tell us, they wouldn’t choose the profession today. They recall a simpler past without insurance-company hassles, government regulations, malpractice litigation, not to mention nurses and doctors bearing tattoos and talking of wanting “balance” in their lives. These are not the cause of their unease, however. They are symptoms of a deeper condition—which is the reality that medicine’s complexity has exceeded our individual capabilities as doctors.
An analogous set of frustrations plague educators, especially in the public system. Even teachers in Jesuit schools, teachers with significant freedom over pedagogy and its delivery, share frustration, if not over the complexity, then over the number of things they are called to do (which generates its own complexity). In Jesuit education, being a good teacher is just the start of what amounts to a considerable commitment of time and resources. An Ignatian educator is usually asked to coach, lead retreats, animate community, build the spiritual life of the students and perhaps head to Mexico or El Salvador for an immersion trip. Sometimes we go to prisons or soup kitchens.
Sometimes we overdo it.
To the assembled doctors about to enter into their complex, highly specialized profession, Gawande gives some great advice, one part of which is helpful for educators. He tells them to hone a “skill that you must have but haven’t been taught—the ability to implement at scale, the ability to get colleagues along the entire chain of care functioning like pit crews for patients.” He contrasts the pit crew model of the doctor to the idea of the doctor as a cowboy, roaming the range in isolation from a larger team. Like the predominant mode of secondary education (one teacher, one class), medicine is not structured for collaboration: “Resistance,” said Gawande, “surfaces because medicine is not structured for group work. Even just asking clinicians to make time to sit together and agree on plans for complex patients feels like an imposition. ‘I’m not paid for this!’ people object, and it’s true right up to the highest levels.”
How many principals and department chairs have met similar resistance to calls for group work and partnership?
Gawande adds a cautionary but optimistic note: “The problems of making health care work are large. The complexities are overwhelming governments, economies, and societies around the world. We have every indication, however, that where people in medicine combine their talents and efforts to design organized service to patients and local communities, extraordinary change can result.”
Gawande ends with a humorous twist, somewhat undermining his dueling metaphors. Turning once more to the comparison of pit crews and cowboys, Gawande said:
Recently, you might be interested to know, I met an actual cowboy. He described to me how cowboys do their job today, herding thousands of cattle. They have tightly organized teams, with everyone assigned specific positions and communicating with each other constantly. They have protocols and checklists for bad weather, emergencies, the inoculations they must dispense. Even the cowboys, it turns out, function like pit crews now. It may be time for us to join them.
The full address is here. Enjoy.
Posted by Matt Emerson.