What can we learn from the medical-education transformation?

I’ve written quite a bit recently about the transformation of the medical education system in the U.S. around the turn of the century. In particular, I’ve argued for a more nuanced understanding of the varied forces that drove the (relatively) rapid improvement in medical education and the medical profession as a whole. I’ve focused on — not to say obsessed over — this history because I believe it offers hope to those who seek to change complex professional systems. And so I will close my little mini-series on this topic by identifying three features of the U.S. medical-education transformation that may be relevant to improving the preparation of future teachers and school leaders.

First, educators within the medical profession led the transformation of the system as a whole. Since Deans for Impact was launched six months ago, I’ve had hundreds of conversations regarding our mission. While most people are generally supportive of our effort, a nontrivial number are deeply skeptical of our chances of succeeding. “Higher education will never change,” I’ve been told.

This simply isn’t true. We have empirical evidence that institutes of higher education can change, and change dramatically. The medical profession in the 1860s was in chaos, riddled with bad actors and dubious methods of training. Less than 50 years later, the profession as a whole had completed a radical and revolutionary transformation. How did this happen?

This effort was led from within. As medical historian Dr. Kenneth Ludmerer explained to the members of Deans for Impact at a recent meeting, “individuals matter … the revolution is in the mind before it’s in the streets.” Despite the enormity of the challenge facing them, leaders in the medical field in the late 1800s “created a vision of what the modern medical school should look like, got the resources, and changed society,” said Ludmerer. The doctors and other medical practitioners prepared under this new system became the vanguard of a more rigorous and scientific profession.

There is no reason why the same cannot be true for the field of educator preparation. Check the banner that runs across the front page of our website: Transforming an education system begins with a collective vision. Individual leaders, working in concert with one another, can leverage their influence to achieve dramatic change. That change will spread throughout the system as future practitioners, namely teachers and school leaders, enter the profession. In many ways, this is the animating principle that underlies all of Deans for Impact’s work.

Second, medical educators shared a common vision of the ideal practitioner they wanted to prepare. One of the more remarkable features of the transformation of medical education is that its leaders embraced a progressive, John Dewey-influenced vision of the ideal doctor as “scientific problem solver.” As Ludmerer explained, this resulted because medical leaders “could palpably sense that medical knowledge was growing so quickly, that no one could know it all … the only way to cope with this onslaught of knowledge [was for medical education] to emphasize problem solving and critical thinking and analysis,” and learn through experience and practice.

I think it’s safe to say Dewey’s philosophical views are not underrepresented in this nation’s colleges of education. But what’s less clear is the commitment to developing the scientific mindset in future teachers.

Now, before conjuring up scary images of teacher-scientists conducting controlled experiments on children — that’s not what I mean by scientific mindset. Rather, I mean cultivating in future educators the desire to connect our best available scientific theories about learning to the myriad contextual problems of practice they encounter, and to the value of collecting evidence to inform present and future decisions. (Bror Saxberg describes a similar vision in describing the potential for teachers to be “learning engineers.”) Scientific mindset in this sense is less about the actual practice of science and more about embracing a set of values associated with science: structured inquiry, skepticism, open dialogue, a desire for empirical evidence, and other qualities upon which we might collectively agree. In my view, this ideal, even if imperfectly realized as it surely will be, is worth striving for.

Finally, the transformation of a profession begins — but does not end — within the academy. As a historian of medical education, Ludmerer’s research and writing focuses on the roles that medical colleges and teaching hospitals played in transforming the medical profession as a whole. Although these institutions may have been the “first movers” in the field, there were many other crucial drivers to systems change. For example, state medical boards elevated licensure requirements, new de facto accrediting bodies emerged, and external forces such as the Flexner Report and public demand for better doctors all combined to accelerate and improve the overall quality of our nation’s medical system.

Can we do the same in education? Can the leaders of educator-preparation programs develop a collective vision and work in concert with other actors across the education profession to transform and elevate the profession as a whole? This remains to be seen. But we know it can be done.

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