Model Practices from Professional Schools

By Gene I. Maeroff

Partnerships can sometimes be built in places where people least suspect the potential for collaboration. High schools and professional schools at universities, for example, may have more in common than educators on either side are apt to realize. Advocates of school reform can find at the professional schools models of some of the very practices that they would like to see adopted by the nation's high schools. At the same time, those who desire to improve professional education have among colleagues in the secondary schools people whom they may discover are striving toward similar goals.

Some of the main objectives of educational reform at both levels are remarkably alike, and paradigms for change can readily be shared. These common interests cut across such diverse areas, for example, as experiential education, off­campus/out­of­classroom learning, integration of the curriculum, and performance assessment.

Activities in two areas of professional education in particular, medical schools and architecture schools, illustrate the possible commonalities. These two kinds of professional schools are in the midst of their own self­examinations, affected albeit by forces far less turbulent than those buffeting elementary and secondary schools. Nonetheless, conversations between those in high schools and those in medical and architectural schools might prove mutually fruitful.

I have had the opportunity in the last few years to participate in studies of medical schools and architecture schools, as well as high schools. Continually, I have been struck by the echoes I hear reverberating across the normally silent educational divide. Those in professional schools and their counterparts in high schools would be surprised to hear­if they could attune themselves to the proper frequency range­how much their stated educational aspirations sound alike.

Take experiential education, for instance. The idea of hands­on education is all the vogue among would­be reformers at high schools across the land. Yet, precious few inroads have been blazed to allow students to go beyond the usual point at which they are passive recipients of knowledge. Learning by doing remains an unrealized aim throughout most of secondary education; even science labs are sometimes taught solely as demonstrations.

In architecture schools and medical schools, however, experiential education often forms a foundation for constructing knowledge. What better examples exist of learning by doing than architectural education's design studio or medical education's clinical clerkship? Budding architects and fledgling physicians use the occasion of their schooling to perform, in a gradually more sophisticated fashion, some of the very tasks that will be central to the practice of their professions.

This is not to say that these professional schools have unfettered themselves from passive pedagogy. Quite to the contrary. Design studios and medical clinics withstanding, some of the most numbing teaching and most mindless rote learning in all of education occurs in the lecture courses of schools of medicine and schools of architecture. At the very same time, though, these schools exemplify in their hands­on courses a level of experiential education that high schools can only begin to imagine achieving. Those who would like to imbue secondary schools with a stronger sense of experiential education could do a lot worse than starting to study how professional schools carry out this mission.

Considerations of experiential education inevitably lead to the related area of off­campus, out­of­classroom learning. Service learning and expeditionary learning along the Outward Bound model represent major manifestations of the attempt by high schools to move education away from the classroom. But programs of this sort occupy only a narrow band of the gamut of secondary school offerings. More creative thinking will be required to enlarge the opportunities of high school students to learn away from the school.

The traditional model for medical education­with the last two of the four years of medical school set in clinics­presents a prime example of how the classroom can be abandoned in behalf of greater learning. In fact, medical schools now seek to extend learning even beyond the hospital clinics that they have used for generations and send medical students to neighborhood clinics, doctors' private offices, and other "ambulatory" sites consistent with the locales at which more and more physicians actually practice medicine. Proponents of ambulatory settings argue that students whose clinical education is confined largely to the wards of tertiary hospitals are likely to focus on pathologies, an orientation that can lead to a distorted view of the role of a physician, especially when prevention looms as ever more important. Furthermore, hospital stays today are shorter and more procedures are performed away from the hospital operating room.

Architecture schools, too, are slowly coming to the realization that out­of­classroom learning ought to be part of the regular curriculum. Boston Architecture Center, for instance, schedules courses only in the evenings so that its students can hold daytime jobs in the field to earn academic credits in connection with the school's work curriculum. The architecture school at the University of Cincinnati operates as a co­op program so that students can alternate between the classroom and the architecture office. But most architecture institutions have been notoriously lax in ensuring that their students get formal learning experiences away from campus, though students and alumni say that this ought to happen.

So far as integrative education is concerned, both secondary schools and professional schools need to do more to bridge disciplinary barriers. Anyone who knows anything about high schools is aware of the fragmentation of knowledge, the utter failure to tie together the subjects that are taught. This issue pervades much of education.

In most architecture schools, for example, education in the design studio often proceeds as if students did not take courses in structures and materials, in mechanical and environmental systems, in professional practice and in architectural history. Frequently, little happens in architecture education to make the design studio an integrative place where knowledge from other courses is formally brought to bear. Such pockets of exception as the Southern California Institute of Architecture, which is trying to involve classicists, historians, and other non­design professionals in studio lectures, desk crits, and juries, represent an embarrassing challenge to other architecture schools.

Similarly, most medical schools continue to adhere to a bifurcated format that keeps the basic sciences separate from each other and unrelated in any formal way to clinical education. Moreover, course content tends to lack coordination, and a student reviews the same material over and over in various courses from a slightly different perspective, perhaps with only a nod to relationships among the subject areas.

A promising integrative approach used by an increasing number of medical schools exemplified by Canada's McMaster University and such American schools as Michigan State University and Southern Illinois University at Carbondale calls for a problem­based format that can be a vehicle for integration, though the explicit goal may be to cultivate clinical reasoning or self­directed learning. Small learning groups of students (not unlike cooperative learning on the pre­ collegiate level, incidentally) seek solutions to problems that usually cannot be solved without drawing on the knowledge of several disciplines.

Such other medical schools as Case Western Reserve University promote integration by pulling together the basic sciences in a coordinated organ­system approach that blends into the clinical sciences, as well. Teams of faculty members from different departments carry out this thematic instruction.

But these are the exceptions. For the most part, high schools and professional schools find it equally difficult to break out of the rigid departmental structure that separates areas of knowledge. In all of education, only some middle schools seem able consistently to put together the teaching teams that readily cross disciplinary lines to integrate content. Most medical schools, architecture schools, and high schools need to find ways to build on these interdisciplinary accomplishments.

The fourth and final of these areas of potential mutual interest is performance­based assessment, a subject of so much discussion in secondary education. The principle that instruction and assessment are opposite sides of the same coin has gotten mostly lip service in high schools, but medical and architectural education took solid steps years ago to embrace the idea though neither of these sectors of professional education extends the approach into all areas of the curriculum.

The basic tenet here is that an excellent way to determine whether a student has learned to perform a task is to have a student learn it by performing it, providing summative assessments while the student gradually builds up the requisite knowledge base and refines the performance over time. The student strives to perfect his performance even as a coach assesses it much like learning to ice skate by repeatedly falling down, getting up, and trying again. If learning means going through the steps of performing a task until it has been mastered, then both carrying out a studio design project in architecture school or conducting a physical diagnosis in medical school are examples of tasks in which the performance informs both learning and evaluative dimensions.

The ultimate exhibition of performance based assessment might be the objective structured clinical examination (OSCE) in medical school or the pin up session in architecture school, two splendid examples worthy of emulation by secondary schools. In a full blown OSCE, the student moves from station to station, encountering one standardized patient after another who simulates symptoms that the student has to diagnose as he or she performs discrete clinical tasks while being observed and marked from structured check lists. In the pin up, the student presents and describes the renderings and models that he or she has developed to solve the design problem.

Thus, we see that professional education and pre­collegiate education share common ground on which to pursue productive discourse. Clearly, an agenda could be fashioned that might prove intriguing to both sectors. When placed in the larger context of schooling generally, the reforms urged on any particular sector of education can be seen to extend into the warp and woof of the entire enterprise. The nature of the changes often transcends differences in the ages and sophistication of learners.


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