This free Information Age Education Newsletter is written by David
Moursund and Bob Sylwester, and produced by Ken Loge. The newsletter is
one component of the Information Age Education project. See http://iae-pedia.org/
and the end of this newsletter.
and Health Care Part 6:
Assessment and Evaluation
"The most dangerous experiment we can conduct with
our children is to keep schooling the same at a time when every other
aspect of our society is dramatically changing." (Chris Dede, written
statement to the PCAST panel, 1997.)
This is the sixth in a sequence of IAE Newsletters based on
comparing Education and Health Care. The underlying goal is to gain
increased insight into ideas that might lead to improvement of our
The term improve
suggests the need for change—in a manner that leads to improvements. It
suggests the need for clear goals, along with valid, reliable, fair
assessment instruments for gathering data relevant to formative,
summative, and long-term residual impact evaluation.
“bottom line” in both Education and Health Care are the customers—the
students and patients. Different groups of people have differences of
opinion as to goals in Education and in Health Care. Thus, there are
different opinions as to what might constitute improvement.
In both Education and Health Care there are studies that attempt
to compare how well various countries are doing. It is difficult to
compare health care among countries. However, there is considerable
data suggesting the U.S. health care system is not the best in the
world (Docteur & Berenson 2009). And, suppose it were the
best? Obviously there would still be room for immense improvements.
is also difficult to compare the quality of education systems in
different countries. Different countries set different goals and have
differing opinions as to what is important. However, serious efforts
have been made to compare the success of education in literacy,
science, and math among different countries. Such studies suggest that
a number of countries are outdoing us in selected curriculum areas (ECS
Cost effectiveness is a key issue, since financial
resources are limited. Thus, as we look at assessment and use of
assessment data in the two disciplines, one issue to keep in mind is
the cost effectiveness. Here is a health care example:
a series of important papers, David Cutler, Mark McClellan, and their
coauthors have argued persuasively that the benefits from many
technological innovations more than justify the rising costs of health
… the most striking evidence came from the rapid
decline in mortality following heart attacks or acute myocardial
infarction. Briefly, they found that between 1984 and 1998, the costs
of treating heart attacks rose by ten thousand dollars in real terms,
but life expectancy increased by about one year. In short,
technological innovations in the treatment of cardiac disease provided
terrific value for the dollar; in this case, the rising costs were
“worth it.” (Skinner et al. 2006).
Comparing cost effectiveness in Education and Health Care
is definitely like comparing apples to oranges. Consider our relatively
large investment in students who are identified as meeting certain
disability conditions as defined in the Federal Individuals with
Disabilities Education Act (IDEA). We do not measure success by
extended length of life. Instead, we measure success by increased
quality of life, self-sufficiency, contribution to the nation’s
productivity, and so on.
How can we tell if Education or Health Care is getting
better? One way is to analyze a particular type of well-defined
problem. Health Care can point to the problem of measles, where we in
the United States once had millions of cases per year and now have less
than 200 cases per year. The worldwide eradication of smallpox provides
another excellent example.
In Health Care, we can also look
at very difficult problems, such as AIDS. This disease is being fought
worldwide. The popular press keeps us informed on progress—and, the
lack thereof—in treatment, prevention, and incidence of the disease.
education, we can gather data on the percentage of students who
graduate from high school with their age cohort. Our nation has set a
high priority on increasing the percentage of students who graduate
from high school or who obtain a still higher level of formal
schooling. We know, of course, that “graduation from high school” is a
very broad term, with huge differences between the learning of
More About Education
education, we can track students over a number of years and attempt to
find causal relationships between performance and treatment (class
sizes, qualifications of teachers, and so on). For example, John
Friedman (2010) presents results from tracking a large number of
kindergarten students well into adulthood. He found that smaller
classes and more experienced teachers contribute to above average
success in Kindergarten, and such above average early success is a
predictor of continuing above average success.
one of the problem areas and a major source of goals in
education. However, research in this area requires agreeing on a
definition of literacy and the development of valid, reliable, and fair
measurement of literacy. Currently, an “average” adult in the United
States reads at a 7th or 8th grade level. Quoting from http://en.wikipedia.org/wiki/Literacy_in_the_United_States
five-year, $14 million [26,700 subjects] study of U.S. adult literacy
involving lengthy interviews of U.S. adults, the most comprehensive
study of literacy ever commissioned by the U.S. government, was
released in September 1993. … This government study showed that 21% to
23% of adult
Americans were not "able to locate information in text", could not
"make low-level inferences using printed materials", and were unable to
"integrate easily identifiable pieces of information." …
follow-up study by the same group of researchers using a smaller
database (19,714 interviewees) was released in 2006 that showed no
statistically significant improvement in U.S. adult literacy. These
studies assert that 46% to 51% of U.S. adults read so poorly that they
earn "significantly" below the threshold poverty level for an
In the second quoted paragraph, notice the attempt to
develop a cost benefit analysis, by linking poor reading skills with a
poverty level of income. The reader might be led to believe that if we
develop interventions that significantly decrease illiteracy, the
result would be a significant increase in the future income level of
those who had gained in their level of literacy. Your authors view this
as an assertion that cannot be justified on the basis of the type of
research that was carried out.
More About Health Care
The Health Care system in the United States is proud of its long-term progress. The Journal of the American Medical Association
(1999) discusses ten great public health achievements in the United
States, 1900–1999. Here are several quotes from this article:
During the 20th century, the health and life expectancy
of persons residing in the United States improved dramatically. Since
1900, the average lifespan of persons in the United States has
lengthened by more than 30 years; 25 years of this gain are
attributable to advances in public health.
Control of infectious diseases
has resulted from clean water and improved sanitation. Infections such
as typhoid and cholera transmitted by contaminated water, a major cause
of illness and death early in the 20th century, have been reduced
dramatically by improved sanitation. In addition, the discovery of
antimicrobial therapy has been critical to successful public health
efforts to control infections such as tuberculosis and sexually
transmitted diseases (STDs).
Healthier mothers and babies
have resulted from better hygiene and nutrition, availability of
antibiotics, greater access to health care, and technologic advances in
maternal and neonatal medicine. Since 1900, infant mortality has
decreased 90%, and maternal mortality has decreased 99%.
In both Education and Health Care we assess individuals.
“How is that patient doing?” “How is that student doing?” In both
cases, we can think of these as formative evaluation questions. We want
answers that lead to improvements in the treatment of the patient and
improvement in the education of the student.
In Health Care,
quality of life is a major consideration. This is perhaps most evident
when the patient is dying and is going to die in a relatively short
period of time An excellent article by Atul Gawande in the
8/2/2010 issue of The New Yorker
discusses this issue and hospice in considerable detail.
education of students with disabilities as defined by IDEA gives an
indication of how our education is able to provide special services for
a designated part of the population. For this group of students, there
is considerable emphasis on quality of life. This emphasis helps to
guide and unify the overall Individual Education Program (IEP) for a
student that may well continue for a great many years.
educators have looked at this IEP approach—education designed to help
students be all that they can be—and wondered why our entire education
system cannot be that way. One answer to this question is that we have
not yet figured out how to provide this quality of education with the
amount of money we are willing to spend on education. Another answer
may be that we are so locked into our traditional curriculum content,
instructional processes, and assessment that we are not able to make
such a major change.
Both Education and Health Care understand basic issues of quality
of life. The two disciplines make use of their understanding of quality
of life in different ways. As Gawamde (8/2/2010) points out, patients
gaining an increased understanding of personal meanings of quality of
life and can play a significant role in making health care decisions
that affect their quality of life.
Our education system
makes an effort to help students understand that the education they are
involved in will affect their quality of life in the future. However,
we currently are not as successful as we would like in having students
gain personal ownership and understanding of this idea.
Docteur, Elizabeth and Robert Berenson (2009). How does the quality of U.S. health care compare internationally? Robert Wood Johnson Foundation. Retrieved 9/5/2010 from http://www.rwjf.org/files/research/qualityquickstrikeaug2009.pdf
ECS (2010). International comparisons. Education Commission of the States. Retrieved 9/5/2010 from http://www.ecs.org/html/IssueSection.asp?issueid=75&s=Selected+Research+%26+Readings.
Friedman, John (2010). Research shows a good kindergarten education makes dollars and cents. National Science Foundation Press Release. Retrieved 8/13/2010 from http://www.nsf.gov/news/news_summ.jsp?cntn_id=117493&org=NSF&preview=false.
Gawamde, Atul (8/2/2010). Letting go: What should medicine do when it can’t save your life? The New Yorker. Retrieved 9/6/2010 from http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande.
JAMA (1999). Ten great public health achievements—United States, 1900–1999. Journal of the American Medical Association. Retrieved 8/12/2010 from http://jama.ama-assn.org/cgi/content/full/281/16/1481.
Jonathan, Douglass Staiger and Elliott Fishcer (2006). Is technological
change in medicine always worth it? The case of acute myocardial
infarction. PubMed Central. Retrieved 8/13/2010 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117353/.
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