November-December 2007

by Margaret A. Miller

I’m an inveterate, if decidedly amateur, tracker of scientific developments (one lifelong result of the Introduction to Astronomy course I took to satisfy UCLA’s general-education requirements—a perhaps-rare instance of their having their intended effect), and so I was intrigued by an article in the New Yorker (Dec. 6, 2004) by Atul Gawande, a physician, about the effective treatment of cystic fibrosis. It seems that there is a huge difference in the survival statistics of centers that treat that disease: Patients in an average center survive to age 30, whereas in the most effective they live to an average age of 46.  

The difference can’t be attributed to the treatment, since that’s basically the same across health centers that deal with cystic fibrosis. It’s due instead, at least in part, to how pushy the doctors are with their patients. The ones at the most effective centers listen respectfully to and think hard about their patients, as well as invent new strategies when the old ones don’t work. But they also cajole and nag the patients to take their medicine, not to slack off—in short, to do their part in ensuring their own health. And they give them the information to do so: written summaries of their visits, copies of their records, mortality statistics for those who do the treatment religiously and those who don’t, and so on.

I was reminded of that article when I listened to the podcasts associated with John Merrow’s recent documentary on community colleges, the making of which is described in his article in this issue. Merrow juxtaposes interviews with three remedial educators, one of whom achieves a 45-percent success rate in his classes (about the national average for remediation) and the other two of whom (they teach together) achieve a whopping 70-percent pass rate.

What accounts for the difference? According to Merrow, the teachers in the more effective class not only listen respectfully to and think hard about their students and invent new strategies when the old ones don’t work—they also cajole, nag, and push students to take their education seriously. When students don’t show up for class, the teachers call them; they roam the room as they teach, so that no one has a chance to surreptitiously surf the Web; they celebrate students’ progress with candy bars and gift certificates; they organize the class into teams. And sure enough, their students end up engaged with the class and succeed at remarkably higher rates than usual.

I confess that this realization makes me uncomfortable. After all, the teacher with the lower pass rate is correct when he says, in response to Merrow’s observation that his students are wearing headphones, reading extraneous material, and leaving after the break, “They’re adults, and if they don’t want to pay attention, that’s their choice.” Christopher Nelson makes a similar point in his article in this issue when he says that “learning belongs to [the learner] alone.”

I also think Thomas Gradgrind’s comparison, in Dickens’ Hard Times, of students to pitchers into which knowledge must be poured was a fatal metaphor; instead, I agree with Nelson that learning is, in his wonderful phrase, one of the “cooperative arts.” But a big part of our job is to motivate students to do their part in creating their own learning, just as it is part of a doctor’s job to motivate patients to attend to their health.

And the paradox is that the result of the pushy teachers’ approach is the opposite of infantilizing: By acting in ways that might seem maternal, they encourage their students to be adults, agents of their own learning. Perhaps it’s because of the way they listen to those students, because of the respect they give them, which the students then reciprocate. As one of the effective teachers says, “If you’re not invested in them ... or not interested in them, then why should they bother? So once you understand the idea of communication with these students, you get respect from them.” The students in their classes, like the patients in the most effective clinics, get the message that their education is important and that they have the right—the obligation, even—to make it a priority in their lives, to give it their full attention.

There are obvious benefits to the institution from this effectiveness: less retaking of classes, fewer “clients” who leave feeling like failures, better graduation rates. But what’s it like for the teachers? What would I have thought about a charge to be this aggressive with, say, my freshman English students?

Aside from worrying about being meddlesome, I think I would have been concerned about the time it would have taken. But phone calls to absent students don’t take a lot of time. Noticing which students are flagging, though—that would have required an intensity of focus that I know I didn’t always have and a willingness to replace my judgments about my most-mediocre students with respect for the complexities of their lives and the effects of previous failures on their motivation.

I would have needed to have faith in those students to persist in pushing them. But I have reason to believe in the miracles that kind of faith can work. When I was a little girl, I discovered that you could be a whiz at kickball if you just ran as hard as you could after every ball, no matter how hopeless catching it seemed. It turns out that your caught-ball average goes way up when you do, since some of those balls turn out to be not so hopeless after all.  
  
You also need serious pluck to face the fact that what you’re prepared to comfortably give just isn’t good enough if you really want results. Gawande talks about how he felt when he realized that he was getting only average results compared to his more-successful colleagues. It was enough to make him question gathering that information at all, since he would have been so much more comfortable had he not known about his mediocrity, not to mention having others see it. But in medicine they’ve discovered that they need to, in Gawande’s words, “measure [their results] and be more open about what [they] are doing” if they want more patients to survive.

Because, at the end of the doctor’s and the teacher’s day, lives are at stake.