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The move from craft to evidence-based practice

The basic structure of teacher-student interaction and the teaching activities which occur in classrooms have changed little during the past 80 years – a fact which has been documented many times (e.g. Hoetker & Ahlbrand, 1969; Cuban, 1993; Cuban & Tyack, 1995; Nuthall, 2007). Compare this with the very considerable scientific and technological advances which have occurred in almost all other professions during the 20th century. Unlike medical practice, where the traditional craft philosophy of patient care was gradually replaced by the revolutionary new clinical science during the first half of the 20th Century (Le Fanu, 1999), teaching practice has remained, to this day, a craft largely untouched by the scientific research on learning and teaching.

A very short history of scientific progress in medicine

Douglas Carnine, who has spent most of his working life engaged in scientific research into teaching, has written a provocative article entitled Why education experts resist effective practices (And what it would take to make education more like medicine) (Carnine, 2000). In this article Carnine observed that teacher educators have much to learn from the way in which medicine, pharmacology, and various other professions have evolved into mature professions. Carnine quotes the medical historian Lewis Thomas who has written of pre-scientific medicine that

“It is hard to conceive of a less scientific enterprise among human endeavours. Virtually anything that could be thought up for treatment was tried out at one time or another, and, once tried, lasted decades or even centuries before being given up. It was, in retrospect, the most frivolous and irresponsible kind of human experimentation, based on nothing but trial and error, and usually resulting in precisely that sequence. Bleeding, cupping, the administration of infusions of every known plant, solutions of every known metal, most of these based on the weirdest imaginings about the cause of disease, concocted out of nothing but thin air – this was the heritage of medicine up until a little over a century ago. It is astounding that the profession survived so long, and got away with so much with so little outcry. Almost everyone seems to have been taken in (Thomas, 1979, p. 159).

During the 20th century, however, medicine gradually transformed itself into a mature, evidence-based profession with the result that life expectancy across the Western world rose from less than 50 years to more than 75 years.

In part this transformation was fuelled by scientific discoveries which, following the second world war, began flowing out of medical laboratories as if medical scientists “had hit the jackpot (which they had)” (Le Fanu, 1999, p xv). Some of the discoveries which had far reaching effects included the discovery of penicillin and many other antibiotics, the discovery of cortisone and the various steroid therapies, the discovery of streptomycin and a cure for tuberculosis, the development of a vaccination for polio, the treatment of hypertension and the prevention of strokes, the development of cancer screening tests, the discovery of heliobacter and the development of a cure for peptic ulcers, and so on.

In part this transformation was fuelled by technological developments such as the development of x-ray machines, CT scanners, ultrasound scanners, the electrocardiogram, the pump, the operating microscope, the endoscope, the ventilator, the kidney dialysis machine, the pacemaker, general anaesthesia, hip replacement surgery, kidney transplants, heart surgery, interoccular lens implants, cochlear implants, intensive care medicine, and so on.

In part, and most importantly of all, the transformation involved the gradual replacement of pre-scientific medical practice with the new clinical science in which medical practitioners not only adopted the diagnostic and treatment procedures flowing out of the medical laboratories but also reported the results of their own careful observations and clinical trials. “Research of any sort is never easy but for these doctors to undertake these studies alongside their primary responsibility of looking after patients suggested a certain zeal and desire for knowledge. This zeal is the defining characteristic of the new ideology – clinical science – that was to transform medicine” (Le Fanu, 1999, p. 198).

Hollman, describing the life of Sir Thomas Lewis describes just how revolutionary the new clinical science was at the time. “He had a passionate belief that clinical science was just as good as any other science, and it would be established as a University discipline … one has to remember that in the 1930s in Britain, the concept of a full-time life-long career in clinical research was … regarded rather as a refuge for those unable to withstand the strains of a consultant’s life” (Hollman, 1994). Yet in the 10 years following the end of World War 2 “the situation where research was regarded as a refuge for those unable to withstand the strains of consultant’s life was completely reversed” and people began to make their reputations by publishing the results of clinical investigations (Le Fanu, 1999, p. 203).

Medicine, says Carnine, now qualifies as a mature profession. “A mature profession … is characterised by a shift from judgements of individual experts to judgements constrained by quantified data that can be inspected by a broad audience, less emphasis on personal trust and more on objectivity, and a greater role for standardized measures and procedures informed by scientific investigations that use control groups” (Carnine, 2000, p. 9).

A very short history of scientific progress in teaching

Educational researchers have been studying learning and teaching for more than 100 years – since Edgar Rice’s 1895 study of the effects of time spent on spelling practice (Nuthall, 2005). In a century of unprecedented scientific and technological development, classroom practice has hardly changed at all. By and large, it remains much the same as it was 100 years ago (Cuban, 1993).

“The scientific revolution that utterly transformed medicine, agriculture, transportation, technology, and other fields in the 20th century almost completely bypassed the field of education. If Rip Van Winkle had been a physician, a farmer or an engineer, he would be unemployable if he awoke today. If he had been a good elementary school teacher in the 19th century, he would probably be a good elementary school teacher today” (Slavin, 2002).

Notwithstanding 100 years of effort, educators have yet to accomplish the task of teaching every non-brain-damaged child how to read the newspaper, how to write a simple descriptive essay, how to perform the main types of arithmetic calculations, and how to behave in ways which will keep them out of prison. It other words, teaching practice has much in common with the medical practice of 100 years ago (Carnine, 2000).

Teachers still routinely assign children to each day's learning activities without any diagnostic testing of the child to determine just exactly what it is that the child needs to learn next (Nuthall, 2007). Imagine a medical practitioner placing each day’s patients on a course of treatment without any attempt at a diagnosis to determine exactly what course of treatment those patients required.

Teachers are still required to make most of their own teaching materials and tests (Twyman, Layng, Stikeleather & Hobbins, 2005). Imagine a surgeon being required to manufacture all the instruments, drips, pumps, anaesthetics, scalpels, clamps, needles and so on required for the next day’s procedures at home the night before.

School textbooks and materials which have never been evaluated to see if they work for anyone are still purchased by schools and routinely used by teachers (Carnine & Bean, 1994; Engelmann, 1992; Grossen & Romance, 1994). Imagine a medical practitioner prescribing a course of treatment which had never by subjected to a single clinical trial and never approved by the Federal Drug Administration or any similar body. “It is . . . amazing to realize that publishers, test makers, and reformers of every color and stripe can “sell” their wares without prior piloting or evaluation” (Lagemann, 2000, p. 238).

Teachers still get paid for doing what they do, that is, keeping children engaged and occupied, and not for ensuring that children learn (Nuthall, 2005, 2007). No teacher is ever likely to be dismissed because some of her students did not learn very much. When a child fails to learn this is still routinely assumed to be because of some defect in the child, not some defect in the teaching provided. Imagine a medical practitioner arguing in front of the Medical Council that his or her patient died because the patient lacked the ability to profit from the treatment provided.

Teacher educators still get paid for turning out graduates who behave like the teachers who went before them, not for turning out graduates who have demonstrated that they can produce learning (Kennedy, 1991; Meier, 1992). In this respect Colleges of Education have more in common with Theological Colleges than they do with Medical Schools.

Clearly classroom practice is not an evidence-based practice in the same way that clinical medicine is an evidence-based practice and teaching is not a mature profession in the way that medicine is a mature profession. Teaching is still a craft. Unlike medical practice where the traditional craft philosophy of patient care was gradually replaced by the revolutionary new clinical science during the first 70 years of the 20th century, teaching practice has remained, to this day, a craft largely untouched by the scientific research on learning and teaching. It fact, one could almost say that teaching practice is a bit like the practice described in the anonymous observation:

"Theory is when you know why it doesn't work.

Practice is when it works but you don't know why.

We combine theory and practice.

It doesn't work and we don't know why."

Section Calls for change
Section What is to count as evidence-based practice?
Section What is to count as evidence?