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Doctors, Teachers, and Professional Communities

An interview with Mildred Solomon

It is fitting that Mildred Solomon named the book she edited The Diagnostic Teacher. In her two decades of work at EDC, she has researched and designed numerous professional education programs for teachers and health care professionals. Now, as director of the Center for Applied Ethics and Professional Practice, Solomon oversees two innovative professional education projects with significant Internet components: PainLink uses a website to provide technical assistance to hospitals seeking to improve their care of patients in acute or chronic pain; Innovations in End-of-Life Care is a peer-reviewed online journal for physicians, nurses, and other professionals working within health care facilities.

Solomon believes there are some essential characteristics of good professional education that hold true across various disciplines. "Every profession has its own discrete skills and concepts, and its own formal and informal rules. Nevertheless, there is a core set of ideas that cuts across all good professional education," she comments. "First, we need to move away from training models that are overly prescriptive. Donald Schon [an organization development scholar]—who worked with architects, lawyers, physicians, etc.—pointed out that most professional training eventually becomes rote. There are trainers, for example, who give teachers a bag of pedagogical tricks they can pull out in various situations. In contrast, high-performance professional education is about solving problems and, beyond that, about posing problems. For example, an excellent teacher can walk into a classroom and identify the areas that need attention. That's what I mean by 'diagnostic' teaching: the ability to assess and predict.

"That same skill is certainly true of good physicians, especially those in end-of-life care," Solomon continues. "They anticipate the likely trajectory of disease—and the whole, broad range of issues that will come up for the patient and family as the disease progresses. They figure out how to prepare the family for those issues."

PainLink and Innovations share a common focus on the importance of planning, communication, and assessment, but they engage health care practitioners in very different ways. "In PainLink," says Solomon, "we've created a virtual community of health care practitioners who want to share ideas and help one another achieve specific improvements in pain management." Each team of PainLinkers from a given health care organization develops its own action plan for quality improvement; they then share their plans online through a common listserv discussion, and on the telephone with senior EDC staff, who serve as mentors and colleagues. "The hospitals joining the program have a vested interest in coming to the site, and they are eager to connect with other hospitals that have made the same commitment to changing their practice," Solomon explains.

Innovations is different in that it is an online journal rather than an online community. Its goal is to collect tools and approaches from across the globe that can be disseminated and downloaded worldwide. According to Solomon, "We are finding innovations that occur in discrete places and bringing them to the light of day. In most traditional peer-reviewed journals, readers only get to see the evaluations of interventions—did the intervention make a difference or not? Most journals are more interested that something was achieved, and less interested in how. The intense focus on evaluation at the expense of process actually slows the pace of innovation, because readers can't get a good, narrative description of what works and what doesn't."

Solomon adds that the Internet allows the journal to create an international dialogue on these innovations: "It's very instructive to compare how people in different cultures and different health care systems define their problems and where they see possible solutions."

Information-sharing and critiques of the kind Solomon describes may be easier to do with doctors and nurses than with teachers. While ongoing education is built into the medical and nursing professions, teachers operate in a very different environment, according to Solomon. In the conclusion to The Diagnostic Teacher, she and EDC colleague Catherine Morocco write:

"Although ample lip service is paid to the notion that teachers are professionals, in fact teachers live isolated lives with little emphasis on their own learning. They operate mostly in self-contained classrooms without even the simplest rudiments of a professional life, such as a telephone, personal computer, or convenient access to professional journals and conferences. Colleagueship is episodic . . . and the opportunities for colleagues to consult with one another in a meaningful way that is focused in detail on student learning and understanding is rare in most teachers' experience." (p. 265)

A truly professional model of teacher development would involve building vital communities of practitioners reflecting on problems together, sharing innovations, and critiquing one another's work. Solomon hopes that projects like those profiled here and in The Diagnostic Teacher can help professionalize teaching by providing greater access to resources and colleagues and building stronger supports for teachers willing to challenge themselves and their practice.

For more information on these projects, visit EDC's Center for Applied Ethics and Professional Practice website.

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"In PainLink we've created a virtual community of health care pratictioners who want to share ideas and help one another achieve specific improvements in pain management."

"It's very instructive to compare how people in different cultures and different health care systems define their problems and where they see possible solutions."