What Schools Can Learn from Hospitals

If you’ve spent your whole life in the public school system, first learning as a student and then working as an educator, you probably have a very clear idea of how it works. In most ways, this is an advantage. However, sometimes this familiarity can also blind us to particularly inventive solutions to the problems that plague our schools today. To open our eyes, sometimes we need to look beyond the education system.

Teachers and doctors may not be viewed as particularly similar, but they are alike in many ways. Both professions require patience and precision, and both have the fundamental aim of helping others. They are also both notorious for burnout and even share the title of “most stressful job in America.”

However, for all their similarities, there are standard practices in medicine that make doctors more professional, prepared, and effective that are nowhere to be found in our education system.

Consider if we trained teachers like doctors through residencies, allowed teachers to specialize and collaborate like doctors, and observed teachers in “instructional rounds.” As our students are willing to learn from us, how might we learn from other fields to improve our practices?


Training Educators like Doctors

Anyone who spends much time talking to first year teachers will probably not be surprised by the report that found that “62 percent of teachers said that they didn’t feel prepared for the reality of today’s classrooms.” This lack of adequate preparation contributes to the many problems facing our education system today: the $2.2 billion lost annually to teacher turnover, the 30% of teachers that leave the classroom in the first 5 years of teaching, and the epidemic of teacher stress and burnout. However, we should not feel as if the distance between reading about teaching in a textbook and actually teaching in a classroom is inevitable and insurmountable—it is no larger, surely, than the difference between reading about an operation and picking up a scalpel.

Borrowing Residencies

After the second World War, the U.S. needed to prioritize medical care and realized that “significant study and practice under the guidance of a skilled practitioner are necessary to ensure that doctors are qualified to serve the public.” This training is not an optional addition to medical education but an extensive requirement for every doctor before they diagnose their first patient or call in their first prescription.

When interviewed about her years learning in the hospital under the guidance of experienced physicians, primary care practitioner Erica Hwang said, “You really learn everything in that time… No one goes straight from reading books to writing real patient notes.” In the past few years, there have been calls to give educators the advantages of residency training as well.

These residencies take various forms under different programs, but the basic concept is the same: teaching candidates spend at least a year working “alongside an accomplished teacher while studying child development and teaching methods.” Residency candidates often begin the school year observing their mentor teachers and end the year teaching full days and assuming most or all teaching responsibilities.

During these months, teaching residents learn to balance theory and practice, receive personalized feedback from their mentor teachers, and form deep relationships with students and other teachers. Most residencies pay their candidates a stipend while they learn; this system treats candidates seriously as productive members of the schools they are serving and allows them to complete residency programs rather than rushing into the workforce to pay the bills.

While candidates in these programs receive an impressive 900 hours of student-teaching experience on average, some programs are even more extensive. Elizabeth Moje, the dean of education at University of Michigan, is opening an entirely new type of school to provide more involved training for teachers: “a K-12 teaching school, similar to a teaching hospital, where future teachers — called interns — will train together under a single roof.”

After finishing their student teaching, interns will stay at the school for three additional years as full-time teachers, working closely with mentors. After those years of nurturing, the interns will then enter Detroit’s schools with the maturity and skills they will need to succeed in a challenging urban environment.

Moje developed the idea for this new school after connecting with a residency director of internal medicine and accompanying him on patient rounds. During these conversations, she noted the vast difference between the years of careful preparation for medical students and the rushed model for teacher training, a program Moje went through herself at 21. Currently, a teacher in Detroit might spend 14 weeks student-teaching fourth grade and then be hired to teach seventh grade English full time.

Teachers trained in this way will almost certainly be overwhelmed and unprepared, a combination that puts teachers at higher risk for quitting. Moje hopes that her school, likely opening in 2019, will help to rectify these issues and successfully borrow the medical model to help build strong, lifelong teachers for Michigan’s schools.

The Costs and Benefits of Residencies

Because of the commitment to provide doctors with hands-on collaborative training, doctor training in the U.S. costs $11.5 billion annually, or about $500,000 for every new doctor. Luckily, teacher residency programs are estimated to require only between $50,000 and $65,000, depending on the type of residency. These numbers include tuition and stipends and, according to the National Center for Teacher Residencies, are “typically paid for by a mix of funding from school districts, higher education partners, and philanthropies.”

This price tag has been justified by many districts because of the high potential benefits yielded by these programs. For example, a recent report found that teachers coming from residency programs were more likely to remain in their districts than other teachers, and NCTR found that “more than 85 percent of graduates from their residency programs are still teaching in their school three years after being hired.” Many teaching residencies also produce satisfied teachers and principals. NCTR found the following results:

  • 95% of their graduates believed “that they entered the classroom with more effective skills that the average new teacher”

  • 91% of principals “said that residency-trained teachers outperform typical new teachers”

  • 98% of teacher-mentors “agreed that being a mentor makes them a more effective teacher”

Teacher residencies can also address the lack of teacher diversity in increasingly diverse classrooms, a phenomenon that contributes to teacher bias and is only projected to increase in the coming years. The Relay Teaching Residency, for example, attracts considerably more diverse teaching candidates than traditional teaching programs; in 2015, 2 out of 3 Relay teachers were people of color, whereas 4 out of 5 teachers nationwide are white.

Although more research needs to be done on the efficacy of teacher residency programs, there is little doubt that training teachers more like doctors is a promising new solution to the problem of teacher preparation.

Educators Working like Doctors

Practicing at the Top of Your License

Once teachers are trained more sufficiently, it will be easier to borrow another helpful medical structure: skill specialization. In medicine, this concept is called “practicing at the top of your license.” If a doctor is practicing at the top of their license, they “perform the maximum allowable tasks and almost nothing that someone on a lower pay scale can do.”

As one doctor puts it, this philosophy means “doing those things that my medical school training has prepared me for” and allowing support staff to take care of the rest.

For example, primary care doctor Erica Hwang asks her support staff to fax laboratory results, draw blood, give shots, and do EKGs. Although she can’t delegate all lower-order tasks, particularly when it comes to precertification for insurance, she says that a collaborative mindset helps her to share responsibilities.

In a sense, she says, her staff is a continuation of her and she is a continuation of them; they all work together to create a “healing environment for the whole office.” At The Graide Network, we propose a collaboration between teachers and Graiders to create a learning environment for the whole school.

Borrowing Support Staff

Teachers could have support staff too, in both formal and informal ways. Parent and community volunteers often play a role in supporting teachers. Photocopying, for example, can eat up precious minutes in a teacher’s day, and it is certainly a task that someone without an education degree could do.

At Eanes Elementary School in Texas, parent volunteers take over the copy room, laminating, stapling, and organizing student work so that teachers are freed up to spend that time focusing on their students. Parent volunteers might be most traditionally found in elementary schools, but secondary teachers should be encouraged to think about any areas of their work that could be delegated to helpful parents.

For more formal support staff, teachers would also benefit from having virtual teaching assistants through The Graide Network. Graiders are aspiring educators trained to give specific, constructive, and actionable feedback on student papers. They can share the burden of grading, one of the most significant time sinks for teachers.

Graiders may not be able to teach in a classroom quite yet, just like a physician’s assistant can’t diagnose a patient, but they are more than capable of productively engaging with student work, often providing more detailed feedback than teachers have time to give. This system then allows teachers to devote themselves to the tasks only they can do, such as refining lesson plans and improving their pedagogy.

Specialization in Residencies

Lastly, using teacher skill specialization would come naturally in a school that already has teacher residencies. In Moje’s proposed residency school in Michigan, for example, it’s not difficult to imagine intern teachers and veteran teachers focusing on different tasks every day, playing to their own strengths and strengthening their weaknesses in a collaborative model. In a 1997 call for this kind of helpful hierarchy, one education professor states,

To truly professionalize teaching, in fact, we need to further differentiate the roles a teacher might fill. Just as a good law firm has a mix of associates, junior partners, and senior partners, schools should have a greater mix of teachers who have appropriate levels of responsibility based on their abilities and experience levels.
— Judith Taack Lanier, former dean, College of Education, Michigan State University

Whether we draw comparisons to lawyers or doctors, a basic principle remains: a system in which all teachers are expected to do all tasks by themselves is simply not an efficient system. If we want better performance from teachers, we have to give them the support they need to teach at the top of their license. Or, in this case, to teach at the top of their certification.

Educators Observing like Doctors

The last structure that schools could borrow from hospitals is patient rounds. From a medical perspective, Dr. Hwang describes patient rounds as the certain time of day “when the medical team goes from patient to patient and summarizes why the patient is there, what transpired overnight, if there are any new issues, and what the plan is for the day.” Medical teams are usually composed of a mixture of students, interns, and residents, and most teams employ the SOAP method for teaching medical students and interns during rounds:

S: Subjective (what the patient says)

O: Objective (what the medical team observes, what labs show, etc.)

A: Assessment (what the medical team thinks)

P: Plan (the next steps moving forward)

Borrowing Rounds

The authors of Instructional Rounds in Education: A Network Approach to Improving Teaching and Learning suggest that educators, particularly principals, can borrow the concept of rounds to improve the quality of schools. Instructional rounds, in essence, are a way for people working in a school system to get on the same page about where they are, where they want to go, and how they might there—all in much more specific and actionable terms than are typically used in these discussions. Through this process, rounds build a collaborative environment committed to school improvement, challenging the norms of autonomy and isolation and requiring the adults in schools to constantly learn as well.

During instructional rounds, a network of superintendents and/or principals visits schools on a rotating basis. While at a particular school, the network splits into smaller groups to visit 4-5 classes for 20 minutes each. During each classroom visit, the participants write down what they see and hear—what the authors call “descriptive evidence,” a closely related concept to the S and O in SOAP. The descriptive evidence would ideally focus on a particular “problem of practice” that the school’s principal is interested in, such as student ability to respond to open-ended tasks.

Are we going into classrooms to learn about the instructional core (interaction of teachers and students and content) or are we going into classrooms to check up on teachers? If the former, it’s rounds. If the latter, it’s not rounds.
— Instructional Rounds in Education

Toward a Shared Vocabulary

Part of the reason why the authors focus so heavily on descriptive evidence is because educators, unlike doctors, do not have a clearly defined professional vocabulary. When one doctor uses the term “patient compliance,” they mean the same thing as another doctor using that term, but education buzzwords like “rigor,” “engagement,” and “higher order thinking” are often used without such coherence. One principal might think of student engagement as students looking at the teacher while another might think of it as students turning in homework.

If “one of the greatest barriers to school improvement is the lack of an agreed-upon definition of what high-quality instruction looks like,” rounds are a way to “create common language, ways of seeing, and a shared practice of improvement.” Therefore, to aid in future discussions, instead of relying on vague and evaluative terms like “fast paced” during rounds, participants instead push themselves to write down specific statements like “Every time the teacher moved to a new problem, I counted at least five students who were still working on the earlier problem.”

Learning from Rounds

After observing and creating descriptive evidence, round participants debrief as a large group, describing and analyzing what they saw and eventually making predictions and plans for the “next level of work” for that school. The following question is often used to guide in making predictions: “If you were a student in this classroom and you did exactly what the teacher expected you to do, what would you know how to do?”

If the answer to that question is, for example, give one-word answers to yes/no questions, perhaps the “next level of work” for that school would be to emphasize open ended questions. However, again resisting the temptation to be vague and again being inspired by the specificity of medicine, the network of round participants might go through the following process:

  1. Hypothesis: “If teachers learn to ask open-ended questions and ask more of them, students will produce more thoughtful answers.”

  2. Solution: Provide professional development for teachers on open-ended questions.

  3. Additional considerations: Teachers would have to learn how to teach students the new thinking skills needed to answer these questions. Teachers would also need to know how to respond to incomplete answers and how to provide feedback to support students’ responding skills.

All of this work, focusing on one school in each monthly meeting and rotating, aims to both 1) grow the knowledge and skills of the group and 2) improve the hosting schools. The collaboration necessary for instructional rounds can also help to encourage a collaborative culture more broadly within a school. After all, “principals cannot lead collaborative learning if they have not experienced it. Students are not likely to take risks, collaborate, learn together, and experience higher-order tasks unless their teachers are doing so.”

Although running county- or district-wide observations is the most established way to conduct rounds, some other educators have suggested interschool rounds, highlighting the benefits of all teachers observing each other in nonevaluative ways.

Whether you choose to include principals or teachers or a mixture of both, the titles of the people involved in rounds matter less than the commitment to the rounds themselves as a new way to collaborate, establish a common vocabulary, diagnose school-wide problems and heal them.

Looking Forward

Although looking to doctors might not be the obvious place to start school reform, drawing comparisons between the two fields can clearly be fruitful. Training teachers through residency programs, allowing teachers to specialize by giving them Graiders and other support staff, and observing classrooms through the instructional rounds system all have great potential to reduce teacher stress and improve student outcomes.

On an even broader scale, proponents often suggest that these changes will help to raise teaching from an occupation to a respected profession, an increasingly urgent task since a recent poll showed that, for the first time, the majority of Americans do not want their children to become teachers.

Teachers deserve the training, support, and respect that doctors have in the U.S. This change will likely require big steps as well as many small steps; if you think we can help your teachers move forward, we’d love to meet you.