Archive for July, 2013

Evidence-Based Education

Many people are not aware that as a physician, I make hundred of evidence-based decisions during my workday.  The practice of medicine is founded on treating patients in a manner consistent with what has been proven to work. The aim of evidence-based medicine is simple: “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients (Sackett, 1996).” There are entire databases and electronic medical record support systems of information dedicated to helping physicians sort through an unbelievable amount of data as they make decisions in real-time. My patient has health-care associated pneumonia with a penicillin allergy? I am a few clicks away – using Up To Date online – from information about the latest evidence on treatment of this condition, with modifications and options for treating my particular patient. If I want to research more in-depth about a medical condition I see frequently, I can go to the Cochrane database and find a systematic review of the available evidence. I can also find and read any number of meta-analyses (studies which aggregate data and findings from multiple smaller studies) on the topic.

Medicine is able to accomplish this because we receive funding for research – to test theories in the lab, or enroll patients in clinical trials. The gold standard for internal medicine is the independently funded (not by the pharmaceutical company) double-blinded (no one who is treating the patient knows what they are receiving), placebo-controlled (some folks receive the drug, others receive an inert pill), randomized controlled trial (patient are assigned randomly to each treatment.) A large, well-designed trial such as this can change the practice of medicine within the course of a year after being published. For instance, when I was a medical student, we routinely placed women on estrogen after they had a heart attack, because the best available evidence at the time showed that we should do this to improve their heart health. After I finished residency, a large trial was published showing that not only were we not preventing heart attacks with estrogen therapy, but that we were potentially causing harm. Over the course of the next few years, the practice of medicine changed, and nowadays essentially no one would start estrogen on a woman after she’s had a heart attack.

However, this data was years in the making. It takes several years -sometimes ten or more – to design, get funding for, administer, synthesize, and disseminate information from a clinical trial. The wait is usually worth it, because we then have good, evidenced-based data on what to do as physicians in treating our patients. New technologies are generally adapted only after they have been proven to work, this protecting the patients from potential harm. If a patient has a time-sensitive condition – such as an aggressive cancer – they are able to be enrolled in clinical trials as new medicines become available.

With the above in mind, it has frustrated me ever since my children entered the school system that education is not more progressive and evidence-based. My child is highly gifted with dyscalculia? I initially spent my time looking for a database of studies, the systematic review with the computer-based decision support to guide her teacher on how to teach her most effectively. What I found were websites and expert opinion articles, but very little evidence-based data. What about the new iPad apps that seem to come out every week to help kids learn math? Should I use the Dragon Box app to teach her algebraic concepts – and algebra? And if I can use it to learn algebra in 42 minutes, why isn’t our school testing and using it right now?

As I searched, I did uncover information regarding evidence-based education. The Best Evidence Encyclopedia  and The Center for Evidence-Based Education have some great information on available evidence, but many of the listed materials on both websites have not been updated in a year or more.  The Ted talks are a great way to disseminate information about current educational practices, but the short talks make it difficult to assess the evidence; the TedEd website shows definite promise in sharing lessons. Dr. Ben Goldacre wrote the a more recent article in March of 2013 entitled “Building Evidence into Education”, and he points out the “need for a coherent ‘information architecture’ that supports evidence based practice.”

My realization over the last few years – driving part of the decision to homeschool our kids – is that education will never be as evidence-based as medicine for my children. I’m not willing, as a parent, to wait while my child sits as part of a study, possibly getting the intervention or not, while she gets older every year. In ten years she’ll be long gone from K-12 education, and while enrolling her in a study would be paying it forward to other students with her condition, it won’t help her now, while she grows and struggles and learns. Plus, there would be countless more iPad apps, technologies, and teaching innovations while the study was underway, so any study would potentially be out-of-date even before it was published.

I do hope that education is able to move in the direction of medicine, with an easily accessible infrastructure that can be utilized from any classroom or household by anyone educating a child. Not so many years ago, colleagues of mine were convincing others in medicine to embrace evidence-based care, and now we can’t imaging practicing any other way. I will watch from a distance as these developments move through education, but in the meantime, I’ve got children to teach.

Neurons Lost and Found Along the Way

Last week had all the makings of a busy one for us: my extended family was in town, my nurse practitioner was out of town, Dave had several project deadlines, and the kids had their usual activities. I spent the week running from one thing to the next, barely remembering to get gas in the car and dinner on the table. I did, however, take time to savor the small moments that make my life “alive”: those connections, like neurons, that strengthen as they are used more. Soaking in the sun as my baby niece swam in the pool for the first time, or listening to Dave discuss his breakthroughs as he tackles projects in his mind while he executes them. Sitting with a patient grieving the loss of her husband. Laying down with my son who lost his fish, or stopping to hug my daughter, one more time. Lounging on the couch while my daughters excitedly showed me their project – a Minecraft model of ancient Jericho.

Each of these moments, these connections, served to remind me how our life as a family has evolved.  Dave and I homeschool the kids together, and we both work part-time.  Summers are really no different, other than we use more of an unschooling method, trying not to do any formal instruction. Our kids explore what they want to –  we sweeten the pot by giving Renaissance Festival money for writing book reports – but otherwise they are free to do as they choose.

Keeping up with their inquiries is challenging, and here’s where homeschooling with a partner is immensely helpful. Truth be told, my brain cannot immediately recall practically anything outside of practicing internal medicine. I did years of high-level math, U.S. History, Latin, Greek, chemistry, physics, and (non-human) biology. My kids will come to me with questions about the structure of molecules, the timeline of Roman history, the evolution of snails – you name it. Questions that years ago, I might have been able to answer from memory. However, years of medical training and practicing have crowded out those neurons for more important, day-to-day activities (such as remembering 20 different passwords to access the medical records systems that don’t speak to one another.) My internal medicine neuronal connections have strengthened over time, while others have faded. Dave, based on the diversity of his business, can certainly recall much more than I can off the top of his head, but even he has a limit to what he can retain.

So, when the kids come to us with a question, we decide, on the spot, whose “area” this falls into. Biology – mine. Anthropology – Dave. Chemistry – mine. Writing – Dave.  Colonial History – me. Calculus – Dave. Even if one of us can’t recall specifics of what the kids are wanting to learn, we are likely to have at least some distant neuronal connections in there that we can dust off and help flicker to life.  We also do what all good homeschooling parents do – we teach the kids how to find and learn the information themselves. Efficient retrieval, assessment, and synthesis of information is a core value skill for both Dave and I, since we use these skills every day in our jobs. We also like to model for the kids that we don’t know everything we’ve studied (I’m certain at least half of what we both learned in medical and graduate school 20 years ago is now inaccurate anyway) and show them how we find answers to our own questions.

As we homeschool together, I sometimes picture Dave and I as halves of one brain. Strengthening connections in ourselves, between each other, and with our kids as we learn – and re-learn – about the wondrous, fascinating world around us.

We are participating in a blog hop this week through Gifted Homeschoolers Forum on “Homeschooling With/Without A Partner.” Check out the other blog posts on this topic!