The Big Fresh May 27, 2017 Tyranny of the Score

Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.

Atul Gawande

In his book Better: A Surgeon’s Notes on Performance, Dr. Atul Gawande shares stories of medical professionals who veer off the normal path in order to improve their work and realize better outcomes. Gawande refers to these people as “positive deviants.”

One positive deviant highlighted is Dr. Virginia Apgar. In the 1930s, this anesthesiologist recognized a problem: “blue babies” were not provided proper care once born. Obstetricians back then assumed there was little that could be done for them. Many newborns in this condition died as a result.

Dr. Apgar came up with a solution: a scaled score up to ten point that doctors and nurses could use to assess the health of a newborn upon delivery. Points were given for a baby’s ability to take deep breaths, move all four limbs, etc. The higher the score, the healthier the newborn. The lower the score, the greater need for immediate intervention by the medical staff. This approach was quickly adopted by hospitals everywhere. Newborn deaths dropped annually. The application of the Apgar score led to other innovations, such as using C-section to lower the risk of blue babies.

The Apgar score is practical and easy to use. However, costs associated with the score started cropping up. Chiefs of medicine saw Apgar scores as a tool to measure the quality of their services. Pressure was put on obstetricians to produce better scores and show growth over time. Doctors started scheduling C-sections when there was even minor risk involved in a natural birth. Women who undergo C-sections experience increased medical risks, including infection, blood clots, and uterine rupture from where the surgery was performed. Recent studies have shown that babies who are delivered via C-section have higher rates of allergies, possibly due to not passing through the birth canal and absorbing all of their mother’s helpful bacteria during the process. The author describes these costs as “a tyranny of the score.”

Does this situation sound familiar?  States and districts use test scores to assess another complex process: learning. Serious negative repercussions have resulted from using one score to determine success in school. Teacher morale is at an all-time low in the United States due to lack of support and loss of curricular control. Students experience decreasing levels of engagement for every year they spend in school. Parents of students taking high-stakes tests ask, “What happens if my third grader doesn’t pass the reading exam? Will he be held back?” In states such as Iowa and Ohio, the answer can be “Yes.”

We are not helpless in these situations. Gawande closes out Better by offering some suggestions for becoming a positive deviant. One is to not complain. “It’s boring, it doesn’t solve anything, and it will get you down.” Lunch breaks in staff lounges are notorious for hosting complaint sessions. Gawande recommends resisting negative talk and keeping conversations focused on positive topics.

Another suggestion is to write something. “You should not underestimate the effect of your contribution, however modest.” This can be a blog post of your thoughts on the effects of standardized testing, or even an article in your local newspaper. Encourage colleagues to write for a broader audience too. Have them include policy makers and leaders when they publish. “By soliciting modest contributions from the many, we have produced a store of collective know-how with far greater power than any individual could have achieved.”

Gawande’s final suggestion for becoming a positive deviant is to change. Look for opportunities within our context and control. Virginia Apgar changed the way doctors assessed their performance. In spite of some consequences, many positive effects resulted because she did not settle for the status quo. As educators, we can also alter how we approach assessment in our schools. What if formative assessments, such as anecdotal records and student portfolios, became a primary means of measuring student growth and success? How could we help students become more involved in the assessment process and better own their learning? These questions and our responses can lead to real change once we realize any score is just a starting point for understanding the needs of the students in our care.

This week we look at creative ways to assess students, and we’ll continue the theme next week. Plus more as always — enjoy!

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