Thursday, December 20, 2007

Direct Instruction

Liam Julian makes a useful comparison here between Direct Instruction -- a curriculum that has proven advantages but that, as I noted a couple of years ago, is nonetheless criticized by the likes of Jonathan Kozol for being too "scripted" -- and the practice of medicine:
It is foolish to believe that big-hearted 22-year-olds will know, intrinsically, the best way to teach reading to a class of second graders, just as it is foolish to think that newly minted doctors can on their own derive the best way for treating a particular pathology. Surely, though, veteran teachers can teach without rigid, Direct Instruction curricula? Not necessarily. A comparison to the medical profession suggests that even the most grizzled teachers (and their students) may benefit greatly from scripted procedures.

In the December 10th New Yorker, Atul Gawande writes about the intensive care units of hospitals, which specialize in saving people whose bodies have undergone seemingly untreatable damage. But it isn't easy. A study by Israeli scientists found, Gawande writes, "that the average [I.C.U.] patient required 178 individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks." And although the nurses and doctors in the study erred in just one percent of those 178 actions, in such critical situations, even the smallest mistakes can have disastrous consequences.

In 2001, Peter Provonost, a critical-care specialist at Johns Hopkins, decided to try making a basic procedural checklist for I.C.U. doctors. His first list was focused on tackling one problem, line infections, which are common in the I.C.U. and can be deadly. Provonost hypothesized that he could curtail such infections by concentrating on simple practices--washing hands, cleaning the patient's skin, etc.--that might easily be overlooked in hectic I.C.U. environments. He convinced the hospital administration to implement the checklist, and "to authorize nurses to stop doctors if they saw them skipping a step."

After a year with the checklist, "the ten-day line-infection rate went from eleven per cent to zero." In one hospital, "the checklist had prevented some 43 infections and eight deaths, and saved two million dollars in costs."

Direct Instruction attempts to do something similar in schools--to make a checklist of sorts for reading instruction, so the basics don't go overlooked. * * *

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1 Comments:

Blogger Marshall said...

I work in manufacturing and we have nearly made a religion of creating and following checklists. I prefer to fly by gut myself because I am lazy and undisciplined, but cannot deny that the rigorous checklist approach yields results. More over, the fact that the script is predetermined and written frees the doctor, teacher or engineer to focus on their mental energy on creative problem solving as opposed to trying to remember simple things.

12:33 PM  

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