Common core is a super hot topic that has a great deal in common with the major healthcare issues facing the public today.
The first commonality is a major misconception in the concepts of standardization as a mechanism for leveling the playing field. Standardized goals do not secure any kind of improvement of a profession or a students education alone. The delivery of the subjects and services are the ultimate arena to be measured but not in examinations. Testing cannot measure the goals of the assessed, it measures some of the attainment of specific skill sets and much of concept awareness, but not the poorly assesses the application of that accumulated knowledge (wisdom). The benefits must be measured in outcomes, eg. for students; better students, better job candidates, better college candidates, better vocational training candidates and for Physicians: better health outcomes for patients, reduced cost of care, better return to work and productive status for patients, recovery of the health activities of daily living, reduction in pain, etc.
The biggest problem for both education and healthcare is one of the common mistake made in many of these discussions. All to often the rhetoric is designed to confuse the communications by using shifting and/or nuanced definitions. This is essentially a bait and switch technique often used to take the focus off the real issues. This is often further clouded by argument with appeals to emotions, leaving logic to the sidelines. Tying testing to earnings raining privileges and licensure has corrupted the measures into tools to control the Dr/Patient relationship while tying testing to advance meant and federal funding has corrupted the measures into tools to control the Teacher/Student relationship. Both have reduced benefits to the end user, the student or the patient.
Standards have existed in multiple professions and in education in a defined way since the early 1900s and had international influences as early as the 1910s and 1920s. The American National Standards Institute (ANSI) and the U.S. voluntary standards system is dynamic and evocative of the market-driven spirit that continues today, but was born during this era. this was the business side of arty regulation, engineering standards etc. If you goole standards in education initially you find sites on standards-based education being birthed in the late 1990s. this is intact far from accurate and ignores an extensive history of educators working to standardize education for nearly a century. the most extensive world were begin in the 1950s and 1960s as the science and space race in particular pressed education to new limits. We needed to stimulate interest in science, mathematics and education here. We succeeded if measured by the outcome of the space race. Technology was the result of that crush but the real motivator was the successful enticement of children to participate in these subjects. The whole of the country was involved in causing these dreams which would become so many very real outcomes that could not have been predicted. Our system of education then became tailored to meet these new demands and we got better students, better jobs, better technology, better medicine, better physicians better healthcare etc.
There were no measures for the dreams of these children, young academicians and physicians.
Most of the business standards were driven by safety issues in the post industrialization era and later on by the technical skills needed to produce anything and everything in this country. Most of the healthcare drive was also from a safety viewpoint in the delivery of care and in the technological explosion of processes and measure to make diagnosis more precise and earlier in the development of disease.
Throughout all this development the problem was not the creation of the standard or the reasoning behind having literally thousands of them to help save lives and make the work place safer, it was the misuse of standards against the work force by management and government that created the monsters we see today. The fact that these same standards were rarely used successfully against the corporate world or political world set the stage for the double standards that has crippled growth in both education (not reform) and in healthcare delivery (not reform). mot often these tools have been used to further sequester wealth from the public or unfairly destroy individuals that worked had to show that the standards were being missed and creating bad news for the public.
Though measurements may make the value of standards assessable, the measurements processes themselves can become cumbersome, or even obstructionist to the advancement of the profession or to the proper application of the standards.
A further misuse of the standard was the building a new set of industries around the standards measurement tools “drilling down” sequentially further until there is little meaning left in the process itself. the outcome of this is most often obstructionist to the application of the standard in meaningful ways.
Common core and ACA have the very same underlying model at work. The business of assessment has taken control of the standard process. The standard has been sacrificed to the assessment tools and the outcomes goals of the end user have been ignored at their personal and fiscal expense.
Requiring that our student population has attainment goals, BUT requiring teachers to teach to the test lowers the students potential to attain a personal maximum. ACA does the same with the capture of medicine and physicians by limiting access to patients and further limiting their ability to decide on treatment by allowing insurance companies the ability to remove heath care options out of the equation. Further more, forcing physicians to submit to standardized testing that is most often irrelevant to their specialty and or their practice takes them away from providing services to their paint population and forces them to study for things that serve their patient population little or none. For physicians to have safety standards has never been the issue, nor has “standard of care” been an issue for the education of physicians. standard of care and safety have however been has been trumped into something huge in the legal profession earning fortunes for legal firms, capturing patient dollars and insurance dollars for the winners in this grossly overstated malpractice/negligence issue.
The fact that tort reform has remained legally allusive is evidence the the system is biased toward paying legal fees irrespective of the validity of the complaint being brought forward. If the loser of the suit had to pay the expenses for the winner as well as for themselves, far less court activity would be happening today.
This effects the schools situations as well. There are far to many cases being allowed to move forward in the court system that are clearly frivolous. This is not to say that there are not cases that need to go to trial nor does it claim that negligence is nonexistent. Placing the fiscal responsibility on the bringer of the case would surely deter the most frequent abusers of the courts. It may also deter a person from bringing a case they might actually be able to bring, but then lawyers would need to assess the case far more critically and determine if the case is winnable rather than collectable.
Standards are often developed as minima, that is they serve as minimum standards and as such have specific measurable goals for a group to meet. In order to create these minima the group demographics and responsibilities need to be defined first, Then the capacity for the groups members ability to attain these measures need to be fairly assessed. Making standards attainable is critical to useful standards. Raising the standards comes when the group is largely attaining them. This is why the standards themselves need to be reassessed frequently and making them cumbersome makes that process expensive and slow. Long term goals and maxima are more often listed as vision statements, mission statements or at the very least global and potentially idealistic achievements. Measurement of these is difficult in the extreme.
Measurement of maxima is more global and flexible and most often is about the entire groups success as opposed to any one particular individuals success.
Even an individuals success is difficult to measure. Is one successful because they make a great deal of money? Is the success based on the safety and benefit to the persons provided the product or the service? is success based on a persons feeling about themselves? Is it based on achieving and academic standard, a certificate, a license, a degree or a document? it has been demonstrated at a national convention by one Dean that her assessment of success was about how many cars, boats and computers one might own as opposed to the alumni associations response that wanted to measure success in medicine by the number of lives saved or the number of patients returning to work. Success is actually partly all these things and really none of them simultaneously. This is the character of success that makes it difficult to measure.
Both the common core and the ACA have been buried by the assessment process and both have succeeded in nearly catastrophic failure due to the reduction in benefit to the end user, the student and the patient.
The assessment processes in both situations do nothing to show benefit in becoming a good student good employee, good college candidate for the common core, or a good doctor, with good outcomes for the patients they serve, or by returning people back to the work force safely and productively Keeping them off the government roles).
Neither group has measures in place that have shown the assessment process as useful to those ends. Teaching to the test or requiring people to study for and produce scores that are not helpful to the simplest endpoint of benefiting the end user in being successful is pointless and expensive. The waste built into this is in the billions to trillions of dollars all by itself in each of these venues.
Teachers are the best trained individuals in developing school assessment process by design and education. Having outside professionals or lay persons tell them what to do without the benefit of their expertise in the development of the standards or the assessment is ludicrous.
Practicing Physicians are the best trained individuals in developing patient assessment processes and health and disease assessment processes by design and by extensive education. Having outside professionals or lay persons tell them what to do without the benefit of their expertise in the development of the standards or the assessment is ludicrous.
Both scenarios now currently in use defy logic except if the only logic used is that of the logic of Wall Street and maximizing earning s for big business and government.
The current use of standardized assessment tools on both arenas is being used in such a way that the larger goals of success for students and the success for patients is being crippled. Teachers and Physicians have been deliberately and systematically removed from the process of goal attainment and tools development at grave risk to the countries security, health and economic status.
The public has been blinded to these truths by the political rhetoric that makes teachers and physicians scape goats, as if they are against progress and safety when in fact there are no persons in any service to our communities better prepared to deliver on both safety and progress.
Teachers and physicians have a great deal in common and should unite in their efforts to restore academic freedom, free market mentality and reduce the assessment process to a locally manageable set of tools.
Big business and big government does not have the answers to everything. Big data is a tool set that needs to be focused on benefiting the common student and the common patient (the common citizen) not on building the economic monopolistic corporate superstructure and government approved methods which have succeeded in depreciating access to quality health and quality education by not allowing either to succeed.
Sincerely yours in service to the communities we serve.
Charles J Smutny III, DO, FAAO
Physician and Professor