Personal Best (to quote Dr. Atul Gawande from his piece in The New Yorker)- Part I of II

Part I of a II Part Blog

Gawande, Atul,  Personal Best, The New Yorker  3 October 2011  p. 44, 46-50, 51-52

I love reading pieces written by Dr. Atul Gawande  as it gives me insight into how doctors/surgeons think.  Understanding a different perspective allows one to ask better questions about their own health care and in my case, also helps me view science in a different way.  What I did not expect, but was pleased to read, was the Malcolm Gladwellian/Freakonomics spin out in this piece about coaching.

Having caught up on many episodes of Bones, Grey’s Anatomy and some bits of CSI, it never occurred to me to think that a doctor/surgeon might wish to be coached to improve their practice/craft.  This is not because I believe doctors/surgeons to be arrogant, rather it has to do with the fact that  they are perfectionists in the extreme and it seemed to me they are constantly trying to be more modern, better, thoughtful, creative.  Doctors and surgeons are as much artist as they are scientist. They perform magic and keep people ALIVE. Who knew they might wish feedback and assistance on minutiae details of their craft?

In the opening paragraphs of the article I kept thinking to myself, “Wow, this is how I think…..and many of my teaching friends and colleagues.” I never thought teachers would come up in the article and was pleasantly surprised when teachers were discussed and most especially how we were discussed.   Apparently education is indeed a life-long process and being coached can be a matter of choice as opposed to a matter of punishment.

Examples (I took out the word doctor/surgeon and intentionally left it blank so you could see how these thoughts could also be by a teacher):

“….my performance in the ___________ has reached a plateau. I’d like to think it is a good thing-I’ve arrived at my professional peak. But mainly it seems as if I’ve just stopped getting better.”

“During the first two or three years in __________, your skills seem to improve almost daily.  It is not about __________, you have that down halfway through ___________.  As one of my professors once explained, doing _________ is no more physically difficult than writing in cursive.   _________mastery is about familiarity and judgement.  You learn the problems that can occur during _________ or with a particular __________, and you learn how to either prevent or respond to those problems.”

“Say you’ve got a _______ who needs __________ for _________……………..Even before you start, you need to make some judgements…………. You have to decide which ____________ to use or whether to abandon the ____________approach and do _________ the traditional way………..Then you’d have to decide whether you need additional ___________ or maybe it’s time to enlist _________.”

“Over time, you learn how to head off problems, and, when you can’t, you arrive at solutions with less fumbling and more assurance……….I’ve come to know most of the _______that could arise, and have worked out solutions.  For the others, I’ve gained confidence in my ability to handle a wide range of situations, and to improvise when necessary.”

“As I went along, I compared my _______against national data, and I began beating the ___________.”

and so on…….

Dr. Gawande discusses his perceived ranking for a bit, acknowledging he desires change and improvement and that possibly this is age in career.

and then this:

“____________(and I use this sparingly as I have no data to support this, but wanted to demonstrate similarities of profession) is, at least , a relatively late-peaking career. It’s not like mathematics or baseball or pop music, where your best work is often behind you by the time you’re thirty. Jobs that involve the complexities of people or nature seem to take the longest to master: the average age at which S. & P. 500  chief executive officers are hired is fifty-two, and the age of maximum productivity for geologists, one study estimated, is around fifty-four.  _________( I use this again sparingly as I have no data to support this, but wanted to demonstrate similarities of profession) apparently fall somewhere between the extremes, requiring both physical stamina and the judgement that comes with experience. “

Dr, Gawande goes on to explore other times he has hit a plateau in life (tennis) and begins to digress into why professional athletes and singers have coaches, but what about the ‘rest of us’?  He discusses many various interactions relating to athletics and singing/professional musicians and states this:

“The coaching model is different from the traditional conception of pedagogy, where there’s a presumption that, after a certain point, the student no longer needs instruction. You graduate. You’re done.  You can go on the rest of the way yourself.”

He continues on with observations as to why Olympic level athletes and  concert-calibre musicians use coaches. The coaches are the external ears and eyes which ‘review’ the performance and offer feedback. Simple, or so it seems.  And the big question:

“What about regular professionals, who just want to do what they do as well as they can?”

At this point, it seems clear and reasonable why Dr. Gawande would seek out a coach for himself. What comes next is the meat of the matter. The article shifts to discussions with Jim Knight, director of the Kansas Coaching Project at the University of Kansas.  I find a bit of fault with one sentence in  the article which research confirms that the big factor in determining how much students learn is not class size or the extent of standardized testing but the quality of the teachers as this negates the all important parent, as if they do not matter.  However, the rest resonates and makes complete sense.

“Policymakers have pushed mostly carrot-and-stick remedies: firing underperforming teachers, giving merit pay to high performers, penalizing schools with poor student test scores.  People like Jim Knight think we should push coaching.”

Information from Jim Knight goes on to demonstrate some small studies of teacher coaching and what Mr. Knight has himself experienced  while teaching writing to students at a community college in Toronto, Canada.  Ultimately this experience helped him complete his PhD and begin a coaching program for schools in Topeka.  While Mr. Knight states encouraging data exists, he notes that not all coaches are effective.  Dr. Gawande then asks Mr. Knight to show what makes for a good coach.

In the example Dr. Gawande views, the coaching is focused on new teachers (generally all new teachers are required to have two years of coaching to clear their credential – this program has different names in each state), however it is open to any teacher who would like it.  Dr. Gawande notes,

“Not everyone has.  Researchers from the University of Virginia found that many teachers see no need for coaching.  Others hate the idea of being observed in the classroom, or fear that using a coach makes them look incompetent, or are convinced, despite assurances, that the coaches are reporting their evaluations to the principal. And some are skeptical that the school’s particular coaches would be of any use.”

One pairing is found – coach Diane Harding and mentee Jennie Critzer.   These two people seem a good fit although there is no mention of whether or not Ms. Critzer has tenure. Tenure can allow a teacher the sense that coaching is, just that, coaching while lack of tenure can indeed make coaching appear targeted to ‘nail’ the teacher instead of being supportive.  Ms. Crizter is observed teaching algebra and then there is the debrief. In this instance, the coaches let the teacher choose the direction for coaching as the teacher generally knows better what their own difficulties/shortcomings may be.

The discussion of the coaching session is well done. Of note, Dr. Gawande states what good coaches do:

“Good coaches know how to break down performance into its critical individual components. In sports, coaches focus on mechanics, conditioning, and strategy, and have ways to break each of those down in turn.” 

  in addition, elite performers are addressed

“Elite performers, researchers say, must engage in “deliberate practice”-sustained, mindful efforts to develop the full range of abilities that success requires.  You have to work at what you’re not good at. In theory, people can do this themselves. But most people do not know where to start or how to proceed.  Expertise, as the formula goes, requires going from unconscious incompetence to conscious incompetence to conscious competence and finally to unconscious competence.”

Humans are resistant to expose their soft underbellies to criticism so coaches have to work around natural defense mechanisms.  Generally, coaches engage in conversation with their mentee and through this interaction, are able to address various points.  Typical questions are “What worked?” and progress to “What did you notice?”  and “How could you change it?”  In the course of this conversation, a person learns how to be more self-reflective. 

Mr. Knight indicates that good coaches have some specific qualities: they speak with credibility, make a personal connection and focus little on themselves……they listen more than they talk (I am guessing like a good psychologist). In addition, good coaches parcel out their communications carefully as they have some discomforting information which is to be conveyed but can be done respectfully.

Dr. Gawande speaks with Ms. Critzer to ask how she likes coaching. It appeals to her. She states the following,

“I’d exhausted everything I knew to improve.”  

 She stated she had begun to feel burned out and isolated. Coaching helped lessen the stress level.

These various ‘exercises’ convince Dr. Gawande to find his own surgical coach, and this person happens to be Dr. Robert Osteen.  In the next paragraphs, Dr. Gawande lays out exactly what coaching was like for him – the good, bad and ugly.  It seems that Dr. Osteen is an outstanding coach and over time the two of them work out a way to communicate so Dr. Gawande feels he can improve.  It can not be easy as we all carry a small amount of ego in us, yet what and how Dr. Osteen talks makes it clear he is ONLY ABOUT improving this surgeon and the patients experience.

The wind down becomes this: Dr. Gawande enjoys having a coach yet it is awkward to explain to other surgeons he is training and a patient he is going to operate on. It is clear that good coaches can foster effective innovation and judgement, not merely replication of technique based on what Dr. Gawande states……the sadness lies in the reality that these coaches may not be so easy to cultivate.

And so, as a population we have to overcome the fear of coaching and truly determine what it is to be used for in professional development – for doctors, teachers, anyone who is desirous of self-improvement.

“For society, too, there are uncomfortable difficulties: we may not be ready to accept-or pay for- a cadre of people who identify the flaws in the professionals upon whom we rely, and yet hold in confidence wha they see. Coaching done well may be the most effective intervention designed for human performance.  Yet the allegiance of coaches is to the people they work with; their success depends on it.   And the existence of a coach requires an acknowledgement that even expert practitioners have significant room for improvement.  Are we ready to confront this fact when we’re in their care?”

If we accept coaching, we have to accept a lack of perfection and room for improvement. There is a difference between self-improvement based on ones free will and desire to improve and the application of coaching as a remedy to what may not even be a problem, just a plateau.

The final  two paragraphs above leads into the second part of this blog as I explore ‘grading teachers’ with the use of student test scores.