What Can Higher Ed Learn From Precision Medicine?
First, it was about access. Then completion. Now, it’s about wellness.
Over the last few decades, discussions in higher education reform have evolved from the concept of getting as many students through the doors of colleges, to making sure they complete their intended pathways. Now, the conversation appears to be shifting toward a question of educational well-being.
It aligns with what we’re hearing from Americans each day in our own Strada Education NetworkSM-Gallup Education Consumer PulseTM , which polls 122,500 people per year. Many Americans — 51 percent — have regrets about major aspects of their education. Some wish they could have changed degrees, institutions or majors. UCLA’s The American Freshman report shows that 84.8 percent of freshmen say that “getting a good job” is the vital reason why they go to college, but our polling has surfaced that only one-third believe they are being prepared with the skills and knowledge to get a job and succeed in the workplace. These are some tough realities. It’s no wonder organizations are starting to focus on educational wellness.
At a conference last month on how colleges can help improve social mobility, many presenters suggested that the health care industry could provide lessons to help treat issues in higher education.
The event was the 2017 Collegiate Leaders in Increasing MoBility (CLIMB) Research Initiative conference in Austin, Texas, and the goal was to continue the work on social-mobility report cards led by MacArthur Genius Award Winner Raj Chetty and his co-authors John Friedman, Emmanuel Saez, Nicholas Turner and Danny Yagan. Part of Chetty’s larger Equality of Opportunity Project, this research identified and ranked all colleges in the U.S. by how they functioned as engines of upward mobility. (The mobility cards have now been incorporated into how Money Magazine compiles its college rankings.) The researchers took every institution and measured how many people coming in from the bottom quintile of income made it to the top quintile of earnings by age 26 to 30. In broadest terms, the mobility cards connect access with success.
Chetty and his team hope that this new research will set the stage for figuring out the treatment effects of different kinds of interventions — in other words, steps colleges can take to improve the outcomes for students. As an example, they’ll be able to measure the value-add of a program like CUNY’s celebrated Accelerated Study in Associate Program (ASAP). ASAP ensures that students complete an associate degree within three years and transfer to a four-year college or to the workforce, by supporting students with everything from a MetroCard to advising, counseling, tutoring and additional financial assistance to cover textbooks and other fees. Ultimately, CLIMB researchers hope to systematically identify other specific programs that add value, replicate and expand these kinds of programs, or help channel more students into such “treatment” options.
The approach compares to how precision medicine is helping patients in the medical context. Some panelists at the conference suggested that we need to move beyond best practices and articulate “safe-surgery guidelines for student success” — focusing on serving students well rather than just the number of students coming through the doors.
The challenge of this metaphor is that most universities and colleges function more like general hospitals. Because general hospitals tackle any disorder in any part or system of the body, they must have one of every kind of doctor, including one in every subspecialty, as well as one of every kind of diagnostic equipment.
Similarly, most universities try to perform many different jobs for many different students. In general terms, most universities offer three value propositions: research, teaching and facilitated networks (within which students work to help each other succeed and have fun). Within each of those three major prongs, there are thousands of subsets of other activities.
At the CLIMB conference, former SUNY Chancellor Nancy Zimpher described how it took her 96 days to complete a listening tour of her 64 campuses. Consider that many of those 64 campuses offer the exact same array of hundreds of different programs and majors for their students — all within the same state. How do we isolate what’s working in such a vast portfolio of offerings?
But what if a college functioned more like a focused hospital instead of a general hospital — and did fewer things with more focus? Measuring outcomes would be a no-brainer. Focused hospitals are built around a very specific value-adding process activity: They take incomplete or broken parts and then transform them into more complete outputs of higher value while charging a fee for the outcome.
As an example, my brother is a retina surgeon. Whenever I do what most people do around doctors and ask him to diagnose some random physical ailment I have, he points to his eyes and says, “Eyes. I’m an eye doctor.” He did his training at Wills Eye Hospital, in Philadelphia, which focuses solely on ophthalmology. There are many more hospitals like Wills. North of Toronto, there is a hospital called Shouldice that repairs only external abdominal wall hernias. In Finland, the Coxa Hospital does only hip and knee replacement surgery.
These focused hospitals offer a narrow set of surgeries at substantially reduced costs, with ultimately higher levels of quality and improved outcomes. At Shouldice, for example, the entire cost of a procedure is 30 percent lower than the standard reimbursement given for comparable hernia repair in the U.S., and the likelihood of complications afterwards is 0.5 percent versus the standard 5 to 10 percent in outpatient general hospital care. Coxa’s complication rates are 0.1 percent as compared with 10 to 12 percent at general hospitals in Finland.
What would a focused hospital look like for higher ed? At CLIMB, New York Times columnist David Leonhardt asked panelists in one session: What do we know that works? Experts like former Secretary of Education John King, UNC Chancellor Margaret Spellings, and Dan Greenstein from the Bill and Melinda Gates Foundation all touted the significance of strong advising as having known positive effects. Not teaching — advising. Good advising begins to look a lot like precision medicine, which at its core involves rules-based therapies that are predictably effective once there is a clear diagnosis. When you move from intuitive to precision medicine, fewer experts are actually needed to solve a problem.
Just think about how any nurse can now do strep throat tests while physician assistants, as opposed to primary care physicians, can adjust blood pressure medications or perform a diabetic patient’s routine examinations. Angioplasty has made way for work that was once in the realm of only cardiothoracic surgeons to now be performed by cardiologists. As each disease moves along the spectrum from intuitive to precision medicine, fewer people with highly specialized expertise are needed to solve the challenges that the particular disease presents.
In our world of education, we see this same shift occurring. Some colleges and universities now make distinctions between instructional design teams, subject matter experts, assessors and mentors. One competency-based institution, Western Governors University, spreads the traditional faculty role among a variety of staff members: student mentors, course mentors and evaluators. In Northern Arizona University’s Personalized Learning program, there are:
- Lead faculty, who create and maintain the curriculum
- Mentor faculty, who serve as student coaches
- Subject matter experts, who function like tutors, interlocutors and conversants with the students
- Graduate assistants, who are responsible for assessments and feedback on the student’s no-stakes exercises
A single instructor or professor is no longer pulled in multiple directions and can play fewer roles.
None of this is to say that professors will become obsolete. But we can now begin to identify the treatment effects of interventions such as better intrusive advising or focused FAFSA help.
These kinds of precision interventions could serve as key factors to a student’s more-positive outlook on his or her higher education experience. This is vital, as so many of our working adults do not or have not had the kinds of campus-based experiences that we tend to glorify. They need a new story to counter their lived experiences, which are fraught with frustration and failure in what one panelist called the “killing fields of college algebra,” or the quagmire of credit transfer and loss — as well as the rising costs that have so many even more suspicious of higher education.
Americans need a new narrative about college and credentials. They are going to need more than a general education. They will be looking for the new precision medicine of higher education.
This column was first published on EdSurge.