Commentary Page, Education Week, October 19, 2005.

Robert L. Hampel

Ed schools periodically aspire to be like medical schools. Twenty years ago, three influential reports envisioned novice teachers as interns, methods course instructors as clinical faculty, and student teaching sites as the equivalent of teaching hospitals. If the best practices of medical schools could be copied, then Ed schools would be able to recruit and retain better candidates. That was the hopeful message in Tomorrow’s Teachers, A Nation Prepared, and Time for Results, three major panel reports issued in 1986.

Twenty years later, it is time to look again at this strategy. The current premium on testing teachers deserves historical perspective. What happened to tests in medical schools in the early 20th century, the era when medical education improved dramatically?

Many medical schools changed nothing. The familiar routine of written, oral, and “practical” exams seemed adequate. Each department created and graded its own tests, and nearly everywhere they required rote recall of facts and procedures. The few innovations occurred before and after, not during, medical education. Selective admissions, rare before the 1920s, eliminated the unqualified, as did tougher state licensing exams. Rather than focus on new tests, medical educators concentrated on other paths to improvement: closer ties with local hospitals, better laboratory facilities, more full time clinical faculty, tougher graduation requirements, and much larger budgets.

But at one of the best medical school—Harvard—the policies for testing and grading students changed during the Presidency of A. Lawrence Lowell (1909-1933). Assessment was only one of several strategies to improve the school, and that is one cautionary lesson to consider. There is, however, another important lesson in the Harvard story: the value of looking carefully at the full scope of what students know and do.

Comprehensive examinations
What held together several dozen courses in a four year curriculum? In medical schools before World War I, the relationships between the basic science and the clinical courses were poorly specified, especially in an age when many preclinical and clinical faculty considered themselves superior to each other ( Lowell compared the rift c. 1910 to the tension between the North and the South in the 1850s). Many of the older, part time clinical faculty knew less laboratory science than most of their students, and they downplayed its importance for the work of a general practitioner. For them the mantra of “science at the bedside” was not as urgent as it was for David Edsall, Dean of HMS from 1918 to 1934 and one of the pioneers in relating physiology to disease. The direction of change throughout American medical research was toward laboratory discoveries with clinical significance as well as clinical investigation carried out in the hospitals’ own laboratories. Harvard was no exception to that trend. The former wariness between clinical and preclinical faculty diminished in the 1920s, when all fourth year HMS students had to take and pass a comprehensive examination spanning the entire curriculum.

“Discuss epigastric pain; its physiological, anatomical, and clinical significance”was one of the three essay questions on the eight hour 1920 comp. Usually the questions focused on a specific illness, injury, or organ, but the discussion of those slivers of the curriculum had to include both scientific and clinical knowledge. Furthermore, three professors could pose any question imaginable as the student examined a patient at an HMS teaching hospital. Rather than test memory, the goal was to see how well the students could correlate and apply what they had learned in various courses.

In addition to grasp, scope, and power (three of Lowell’s favorite words), the comps fostered self-reliance. The current enthusiasm for tight alignments in teacher education between curriculum and assessment would have worried Edsall. For him, the comps encouraged independent reasoning. Students could not cram for the capstone exam by taking certain courses, reading particular books, or hearing some lectures. Edsall resisted any curricular changes that would foster “spoon fed correlation” where the teachers “do for the student what he should do for himself.” When Abraham Flexner referred to the comps as a “system,” Edsall told him it was the opposite. The point was not to set up more requirements; medical students instead needed the freedom to cross course and department boundaries to find and use whatever knowledge applied to the problems at hand.

In undergraduate teacher education today, we rarely ask our students to correlate the mass of information they acquire. We hope that the sequence of coursework by itself will establish connections among courses, but we offer few incentives for candidates to integrate coursework in or before their senior year. With increasingly detailed specifications from NCATE and the states, we are prone to tell candidates exactly what they must do rather than encourage them to develop their own clinical judgment, to use, as Edsall said, “what he has gained from any and all sources—not to determine simply how much of this he can remember, but how well it serves him in comprehending and elucidating problems” of professional practice.

Comprehensive assessment
Edsall and Lowell faced another challenge: very few professors changed the short answer factual course exams given since the 1870s. “Gangrene of the toe” “Discuss treatment of an infected knee joint” “The surgical bearings of choked disc”: third year surgery exams, for instance, posed the same type of items created forty years earlier.

Tests sought definitions and summaries, as the most frequent first words of the questions indicate: What is…, Give an account of…, State…, Explain…, Name…,Describe…, Enumerate…

But the importance of the grades derived from those tests lessened in the 1920s. Admission to fourth year elective courses no longer turned on high grades. Special Honors was awarded for excellent work in one particular area, and regular Honors required good work on the comps along with good grades. Individual class rank gave way to placing students in the top, middle, and lower third.

Most crucially, promotion now depended on the recommendation of a faculty committee that could change course grades as it awarded one cumulative mark for the year’s work. The faculty relied on its impressions of the entire scope of the students’ work rather than calculating GPAs or using standardized tests, which were sweeping the country at that time. Watching performance in many settings—labs, outpatient clinics, hospital wards, class discussions, seminar meetings-- provided a better gauge of fitness than a clutch of test scores. “Careful and close examination of the individual student” is essential, one professor told the Dean, who after 1925 asked each instructor to send written comments on the students to his office.

Don’t teacher educators today also scrutinize a wide range of student work? For sure—but do we discuss student work with each other as often and as thoroughly as the HMS faculty did? By creating three “Promoting Boards” along with a large “Committee on Examinations,” HMS set up unprecedented organizational support for the frequent discussion of students. Before the 1920s, that happened informally, usually when problems arose, but now there were structures in place to make sure it happened all the time.

Personal attention, knowing students well, could not be avoided or delegated to others. That would have been easy to do in a decade when enrollments rose and when research productivity became more important than ever. It is not surprising that some faculty yearned for external examiners or a paid in-house staff, but to his credit Edsall refused to subcontract the work. He knew that is was not easy. Each spring the readers of the comps devoted 35 to 45 hours to their job. They read answers in which some students still piled up long lists of facts rather than think critically. They received exam questions from colleagues that were much too broad (“Discuss milk”). The comments on individual students varied in length and cogency, including one remark on a man who had never enrolled.

Even so, Edsall and the faculty persevered. They believed in the importance of knowing each and every student well enough to share and defend those impressions with their colleagues. Shouldn’t we know our preservice candidates well enough to do the same? Rather than file bits and pieces of NCATE driven tasks in electronic portfolios, shouldn’t we get to know each of them as unique individuals and then ground our assessments on our overall sense of their strengths and weaknesses?

Robert Hampel is the author of The Last Little Citadel: American High Schools since 1940 (Houghton Mifflin, 1986) and coauthor of Kids and School Reform (Jossey Bass, 1997).