Perhaps because we have come to assess businesses through the “bottom line,” that is, through numbers, we have begun to feel that everything can and should be quantifiable. We put grades on restaurants, as though a spot check can really tell us how safe the food is to eat (it can’t). We put grades on doctors and on teachers, believing we can place a numeric (the grades result from numbers) value on complex interactions affected by factors outside of the control of patients and doctors, students and teachers.
We think we can tell “best” from “worst” through assessable “outcomes” that might (and do) include such things as success rates in surgery or on standardized tests.
Albert Schweitzer would certainly rank among the “worst” doctors in terms of outcomes. Of course, he was working in what amounted to crisis situations… but that wouldn’t matter to the numbers. Maria Montessori, if she were to be graded on standardized outcomes on the part of her students, would never have dared create her Method of “discovery learning.” It leaves too much in the hands of students.
We don’t get the best through the sort of ranking resulting from our corporatist and assessment manias, but the most conformist and the most manipulating, those more interested in their own grade than in the more generalized welfare of their patients or their students.
Sandeep Jauhar, writing in The New York Times today about grading physicians, says this about what happened when surgeons were forced into an assessment paradigm of report cards:
[T]he report cards backfired. They often penalized surgeons, like the senior surgeon at my hospital, who were aggressive about treating very sick patients and thus incurred higher mortality rates. When the statistics were publicized, some talented surgeons with higher-than-expected mortality statistics lost their operating privileges, while others, whose risk aversion had earned them lower-than-predicted rates, used the report cards to promote their services in advertisements.
In addition, he writes, “The best surgeons tend to operate at teaching hospitals, where the patients are the most challenging, but you wouldn’t know it from mortality statistics.” By the same token, the best teachers often work in the most challenging situations, leaving the easy instruction of motivated students in well-funded institutions to the more mediocre. Their grades, however, are going to be worse than those of teachers of students who entered their classrooms well prepared from home. The best college teaching I’ve seen often happens in community colleges where the emphasis is heavily on the classroom. The students may not be the best, and their “outcomes” may not be as high, but the instruction they receive is often remarkable.
It’s wonderful to see people beginning to react against the mindless grading that recently looked like it was going to come to dominate fields like medicine and education–and even food service. I hope the trend continues.