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Being patient and getting results!

David Hargreaves once wrote a paper in which he compared education and medicine and expressed the view that education could learn quite a lot from that other discipline and the profession that practices it.

For the past six weeks I have been able to observe doctors and nurses going about their daily work in a number of settings in two hospitals as a Family Member embarked on a journey through a series of complications ranging from the serious to the not-so-serious as a sequel to a major operation. This has included such settings as specialist wards, general wards and two different intensive care units. So on the basis of this extensive “research and observation” I offer the following reflections.

It is clear that medicine is much more research driven than education. They bring the results of research into their decision-making, the tools they use and the procedures they apply. I saw no evidence of leeches being applied, blood being let for the sake of it or of poultices being randomly applied. Yet in education we continue to use practices that don’t work well past the time when evidence has made us aware of that.

Medicine bases what they do on careful and scientific observation (aided by incredible technologies it must be said). When they make assessments it is on the basis of evidence, what they see and know. Of course there is a role for experience, judgment and intuition. But all these attributes are applied in a controlled and measured manner.

And on that matter of technology – it is apparent at every level of the practice of medicine and it is clearly a wonderful tool that assists professionals to do their job. Do we have this orientation in education? Or do we too often think that the technology will do some or all of the job by itself. I forget who said that the teacher who thinks that technology can replace the teacher deserves to be. I saw technology being used to allow the skills of professionals to flourish.

Team work. I observed specialists from different disciplines working as multidisciplinary teams and wondered why this still challenges us in education. How often do we daily bring to bear the different skills-sets of different educational practitioners to bear on the issues of achieving positive results? Yes, occasionally but certainly not enough. In the intensive care units single nurses have high levels of personal responsibility for a patient but in close proximity are other nurses with similar responsibility for their patient. And when one needs help from the other it is easily and willingly there.

Instead we place teachers into settings where they are physically as well as professionally isolated. It is a difficult undertaking rather than an easy norm to achieve this level of team work balanced with individual responsibility in many education settings – in one it is the patient that benefits and in the other the student who must be patient!

Another area that impressed me was the relationship between the close family of the Family Member and the professionals. Even in the most troubling of moments those who cared greatly were made to feel welcome and even brought into the innermost sanctums of the workings of the hospital. Information was forthcoming, briefings given patiently and in terms we could understand. The well-being of not just the Family Member but the small group around him were a clear concern.

Why then must the educative processes be practiced at a relatively remote distance from the families and caregivers? It seems almost verboten for family members to get into classrooms or even past the front office. The orchestrated “report evenings” are offered as a morsel of consultation and attendance reported as something of a meaningful thing yet ongoing involvement of the closest group of the student is often denied. It seems neither good practice nor conducive of the best environment for learning that sees connections between home and school.

Finally – and this was a great joy of the past six weeks – the application of knowledge and training to the real world was apparent at every point. I work in an institution that trains nurses and they undertake clinical practice in the same hospitals that I visited so often. The trainees were identified by their logo on their trainees uniform and I have had many conversations with them. They expressed not only the pleasure their experiences were bringing to them and the helpfulness of them to their development but also an affirmation that they had made the right choice. They “loved it” and “really wanted to be a nurse” and were “really excited” that they were heading towards such a worthwhile job.

Gently questioning identified those who had trained and were now flying solo. Nurses of different experience including those out of training relatively recently were given real responsibilities and supported and supervised but real responsibilities nevertheless. We see this in young teachers. But do we have a joyful workforce? Are people in education the cheerleaders for education?

And the good news? Family Member is going home this week. There is a commonly held belief that when the chips are down the state health system is second to none. Can we say the same about our state education system?



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Talk-ED: The helping professions

Stuart Middleton
31 September 2011

I called into a health conference to make a contribution and once I was struck by the extent to which the two areas – health and education – were similar in all but two respects.

They are both similarly based on a fundamental value of service to people, we both do what we do because someone else has a need and when that need is met we leave the world a better place, well at least for them.

Both our groups work in teams, each health or education professional is necessary to the process but never in themselves sufficient. Managing this relationship between the members of the team and recognising the value of what each contributes to the team’s mission and to its outputs is the mark of a professional. But the success of our contribution also requires us to act with high levels of autonomy.

Health and education call for practitioners who are committed to reflective practice. Being able to reflect on what is happening or has happened and to adjust practice to take account of that reflection requires high level understanding of a number of things – the needs of others, the appropriate range of interventions to take, the signs of progress (or lack of progress perhaps), the willingness to consider the contribution made to the work of the team, an awareness of the strengths and limitations of oneself and so on.

A further clear similarity is the institutional nature of the place in which the arts of healing and teaching are practiced – hierarchical, predominantly public service in origins, current focus on managerialism, and so on. Being big ticket budget items for any government, they are also very political.

Finally there is the impact of the success of what is done – both affect lives. In health unsuccessful interventions could result in death or prolonged suffering. Issues in education, while not life threatening in the dramatic sense, are at least critical to the quality of life, the capacity to earn and the ability to provide for others. Both are central to happiness and peace in our lives.

But there are two critical differences – response to research and the uptake of technology.

Medicine is essentially highly responsive to research and indeed is research driven. New techniques of treatment, new drugs and their use and new regimes for recovery come directly from research to shape new practices among health professionals. Those working at the patient or community front are well-informed by research and are diligent about their continuing professional development.

On the other hand, education is sluggish in its response to research. The vast industry of educational research has always found it hard to make connection with and to inform classroom teaching – we continue practices long past the point when we know that they are not working, that there are better ways of working.

I speculate that the big difference has two explanations.

The first might be that health researchers work more closely with those who practice whereas in education the gap between research and practice seems never to close.

The second might be more critical. The health sector is largely self-monitoring. It disciplines its members who transgress, it admits into membership those who meet criteria of both qualifications and competence and they lead the public discussion. The government health agencies don’t control the participants but are left to manage the delivery vehicles – hospitals, Pharmac and so on. By comparison education, the school sector especially, is centrally controlled and managed with less devolution to the professionals in the schools than might be suggested by the model of governance that we use. Tertiary institutions are closer to the health model.

A self-monitoring and self-managing sector is much more likely to also accept the additional responses of continued development professionally.

And lastly, there is the matter of the uptake of technology. Both at the conference I attended and whenever I visit someone in hospital I am amazed at the uptake of technology and the specialist and advanced applications of it to the practice of administering and delivering health interventions. Hospitals are changed places in appearances, applications of technology and subsequently practice.

By contrast, schools are very much slower to change and new technologies find a place largely to replicate and reflect old pedagogies. Compare, for instance the way in which technologies allow for asynchronous teaching delivered flexibly over distance with the requirement that the greater part of instruction in schools and institutions takes place with designated groups who must assemble in a particular room at a certain time who must progress through a programme in a lockstep manner! This might be a result of having to work with groups.

I enjoyed my day amongst the neonatal nurses at their conference – we don’t spend enough time with other professions.

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