We Don't Need Anesthesia, It's Painful This Way and That's How We Like It!

If you needed surgery to save your life and you had a choice to have the surgery with an anesthetic or without, which would you choose? Which option do you think your doctor would recommend?

Today a surgeon wouldn’t think of performing painful surgery without anesthesia, but there was a time when surgeons couldn’t imagine surgery without pain...

Robert Krulwich interviewed Richard Holmes on National Public Radio's Morning Edition yesterday about his book Age of Wonder. Holmes recounted that in 1799, Sir Humphrey Davy, then a 21 year old scientist and apprentice to a surgeon discovered that nitrous-oxide (laughing gas) could stop pain.
In his book, Holmes describes Humphrey Davy’s discovery and his suggestion in an article to the medical community that nitrous-oxide could helpful for patients undergoing surgery. Unfortunately, it took 40 or more years for surgeons to see past preconceived notions about pain and accept that pain was not necessarily a good thing. They just couldn't imagine surgery without pain.

Here is an excerpt from the NPR interview:

"The idea that you could have pain-free surgery was completely radical, novel," says Richard Holmes. Doctors at the time had a different view: that pain was a good thing! The doctors thought pain helped them polish their surgical skills (screaming being a prompt to cut fast and accurately), and it was believed that pain would help the patient rebound. "It was proof that the body was fighting back and healing itself," Holmes says.

The education profession can be like the medical profession of the early 19th century. We know that the way things have always been done in schools is not working for many students, but we "can't image" it working any other way. We have new discoveries from brain science research, new methodologies and innovations that could stop the "suffering" and meet individual student needs. We have a better way, but lack the collective vision and will to put such a radical change into practice. It is a crisis of belief, what I like to call "cultural inertia", that prevents individuals and groups from seeing the answer that is right before them.

Maggie Dugan and Tim Dunne at InstantBrainStorm said it well in this video clip about the "aha moment". (They graciously produced this clip for me to use in a presentation to the National School Boards Association annual conference back in 2009.):


I hope it doesn't take 40+ years for the education profession to have an aha moment, to see that learning can be less "painful", to imagine a system where all failure to learn is not the norm.

How can students reading significantly below grade level catch up?

Students reading below grade level are not only behind in reading, it is also harder for them to keep up in other classes when text books and other content are written at grade level. Part of the solution is providing reading materials across the curriculum tailored for the student’s reading level. Richard Allington, one of the country's most recognized experts on early literacy, addresses this in a recent EdWeek article (http://www.edweek.org/tsb/articles/2010/04/12/02allington.h03.html?cmp=clp-edweek):

“…reading instruction has to take place all day long. In other words, if he’s reading at a 2nd grade level in 4th grade, this child would need texts in social studies, science, and math that are written at the 2nd grade level but cover the 4th grade curriculum, so he has a book in his hands all day long that he can actually read.”

Of course the reading instruction itself must also be adaptive and effective. Students reading below grade level must have more time reading with the right materials, and the reading instruction must be high quality and adaptive to individual needs and learning style. Allington asserts that the teachers working with these students must be trained to use proven instructional practices, that far too many teacher don’t know how to teach kids to read. This includes teachers providing pull-out instruction in small groups or one-on-one and teachers in the typical classroom setting.

Allington is critical of packaged reading programs. “Well, the problem is that the concept of a packaged reading program doesn’t have any scientific validity to start with, because we know that if you take 100 kids or even 10 kids, there are no prescribed programs that will work with all of them,” he said. I think that might be true for one-size-fits-all classroom-centric packaged programs. However, I would argue that computer-adaptive "packaged reading programs" can work with most students if they are created by experts in reading instruction and apply the same diagnostic and prescriptive logic that would be applied by a reading specialist when working on-on-one with a student.

I don't claim to have expertise in early reading instruction, but I would argue that the factors that make good computer-based reading instruction effective when compared to static reading programs, are some of the same factors that set apart good reading teachers from those who don't know how to teach reading. The teacher (or program-logic) must continually assess how well and how the student is reading (using a variety of indicators). More importantly the teacher (or program logic) must recognize WHY the student is struggling with a particular aspect of reading, and know the appropriate response(s) to overcome the block. The response must fit the need, be it strategies for coping with dyslexia, more time reading engaging content matched to the student's interest and ability, or activities to strengthen phonemic awareness.

It is the diagnostic and prescriptive ability of the teacher, or similar logic within the "packaged reading program" that makes it work for the individual learner. Research is now being done on biometric feedback that can give the interactive program some of the cues that a good teacher would use when observing a struggling reader (e.g. vocal inflection when reading out loud, eye position when reading on screen or device, posture). While traditional outcome-based assessments can diagnose competency, these in-process cues can help diagnose process problems, and point to appropriate remediation.

Personal one-on-one instruction for all struggling readers with highly proficient reading specialists would be the ideal, but would be cost prohibitive. An effective alternative for many students could be an interactive one-on-one program, designed with the knowledge of top experts on early literacy and with the diagnostic and prescriptive logic of proven-practice reading instruction. I predict that such programs will increasingly be accepted and proven scientifically valid as our education system shifts from a teacher-centric model to a student-centric model.