Friday, March 11, 2011

One Test to Rule Them All

Nearly 60 years ago, an anesthesiologist named Dr. Virginia Apgar devised a simple test that all parents are familiar with. The Apgar test looks at five criteria to quickly determine the health of a newborn. A healthy newborn will generally score between 7 and 10.

The story of Dr. Apgar's test is an important lesson.

On the face of it, the Apgar test is ludicrously simplistic. In theory, a baby could have no pulse but still score a perfectly healthy 8.

But the Apgar test is good enough. And more importantly, it's better than nothing. Because that's what doctors used to have.

In the book Better, my man crush Atul Gawande states, "the score turned an intangible and impressionistic concept—the condition of new babies—into numbers that people could collect and compare (p. 187)."

Basically, doctors now could tinker and gather the results to see what worked. There's a lovely passage about how doctors are supposed to be "evidence-based" but in obstetrics the doctors just tried stuff out and looked to see if results improved.

They had a number and if it went up, they knew they probably did something good. If it went down, then back to the drawing board. Before the Apgar test, 1 in 30 newborns died at birth. Now, it's 1 in 500 (p. 187).


Gawande also points out that the number of Cesareans has increased dramatically. In part, because of that all important Apgar score. He uses the phrase "tyranny to the score" here, which I love. Doctors, being the type A overachievers that they are, seek to maximize their score as much as possible.  Sometimes they do so at the expense of other considerations. Again, quoting, "While we rate the newborn child's health, the mother's pain and blood loss and length of recovering seem to count for little. We have no score for how the mother does....(p. 198)" Being the good teacher doctor that he is, he goes on to suggest multiple measures.

So what do I take from all this? I used to spend hours creating and revising the perfect assessment. I'd stress about word choice. I'd wonder if I was giving too much away or not enough info. I'd try for that perfect balance of academic vocab and accessible language.  I'd try to cram in 60 questions in 50 minutes or have them write a full lab report in complete silence.

Except that there aren't any perfect assessments. What's perfect for Student A is highly flawed for Student B. It does not exist. But there are certainly better and worse assessments.  So like the Apgar test, I try to make my assessments good enough. Multiple "pretty good" assessments give a more complete picture than any single "great" one possibly can.1 And NEVER EVER let any one score dictate everything.

1: Falling in love with a single assessment, lesson, lab, demo, whatever... is one of the cardinal sins that very good teachers make. I know I can become enamored with a lab and stop being critical of it and working to improve. I start to think it does more than it actually does. And yes, I try to work to keep my SBG love in check.

PS - I've gotten more out of the Atul Gawande's books than any other of the "not in education" gurus we end up reading, like Dan Pink, Malcolm Gladwell or Jim Collins. I keep meaning to blog about the chapter he wrote on cystic fibrosis care. Best chapter ever. Go to the library this weekend and read it. The chapter is titled The Bell Curve and it will burrow deep into your brain. 



  1. He's MY man crush as well!! Actually, I've met him at a book reading and he's just as amazing in person. (I should have offered to have his baby then. What was I thinking??)

  2. By the way, Atul Gawande himself sees numbers as one of the best ways to track progress over time, because 1. they are not ambiguous or lengthy like anecdotal reports and 2. they make the people that are responsible feel more accountability immediately, and therefore heightens their eagerness to perform. Part of the Apgar lesson (if I remember correctly, either from his talk or his book) is that it made it super easy to compare how hospitals were doing against other similar hospitals.

    So, if you want to apply that to teaching, it could be similar to periodically rating kids in different areas (based on a rubric), and then analyzing those numbers thoughtfully over time and/or comparing them against those scores of other classes (say, a common rubric shared by all middle-school science teachers). The thing we'd have to be careful about is to not turn it into a finger-pointing sort of thing, but as an opportunity to examine how we are doing collectively and individually.

  3. I've only read one of Gawande's book The Checklist Manefesto. It was enough to recruit me to the cult of Gawande, and I will be looking into his other books soon.

  4. I've got The Checklist Manifesto on my bedside table waiting to be read. I'm looking forward to it.

    I just had to note that blogging about books like this one makes me question your statement about only reading books geared at 9-12 year olds.