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Education in America

Question: How do you see the state of public education in the U.S.?

 

Joel Klein: So you can look at this from so many different points of entry. Let’s take an obvious one. If a doctor went to sleep 50 years ago and woke up today, nobody would allow that doctor in a hospital to do surgery.

But if a teacher went to sleep 50 years and woke up today, and she were a good teacher, people would be excited to have her in the classroom. Education is a kind of area that really lacks innovation, lacks entrepreneurship, and lacks dynamic thinking, it’s very homogonous. The debates are so arid, how long are we going to have the same debates, you got to find the perfect curriculum, you’ve got to be able to have this class size versus that class size, you need to invest more in this or a little less in that.

Those are important debates, don’t get me wrong. But those debates are absolutely inconclusive and aren’t going to get to the issues that I’ve been hoping to be able to effectively communicate here, which is that if you reward mediocrity, if you pay people whether they do a great job or they do a poor job, if longevity of service is the most important factor in divvying up the benefits in this system, then the system won’t work.

You don’t know systems that work and which aren’t built on meritocracy in which excellence isn’t really the thing that people are searching for and which excellence is rewarded and which the toughest assignments are oftentimes the assignments you want your most talented people to go to.

All of those things are misaligned in public education and they’ve been for a long time. In large measure, public education is built on a civil service, trade union industrial model, and we need to move it to a professional model in which excellence is rewarded, incompetence is properly dealt with.

The toughest jobs attract highly talented people so that our poorest kids get a fair shot at a great education. And those kinds of phenomena have to be addressed and addressed meaningfully. They’re very painful to address because they will require a rethinking of the way we deliver educational services in the United States. But unless and until we get serious about that, I don’t think we’re going to really see the kind of shifts that we want to see.

It’s 54 years after Brown versus Board [of Education] when the Supreme Court not only outlawed segregation, but promised every kid in America an equal educational opportunity. It’s 25 years after a nation at risk in which all the problems we’re talking about today were identified.

And yet today in America, education is not equitably distributed. Where you grow up, what your family background is, affects the quality of the education you get. And that’s in large measure because we haven’t really come to grips with the issue of the equitable distribution of adult talent in a system. And until we address that, we’re going to continue to have the same kind of, in my view, arid discussion about yesterday’s policies and yesterday’s programs.

 

Question: What do you think is the right balance between public and private oversight of education?

 

Joel Klein: In the end, education is a government service and the government has got to be responsible. It cannot outsource it, it cannot decide that third parties will do it, although you can bring in third parties, as we’ve done in New York City, you can bring in competitive principles, you can bring in accountability and you can bring in innovation. All of those things are critical to the transformation, but in the end the government has got to be accountable.

If you think about it, it’s so weird, we’ve have school boards, basically, running education. And they’ve been guided by the politics of paralysis. If you read Matt Miller, who I’m sure is one of the real powerful thinkers in this area, he’s got a piece [titled “First, Kill All the School Boards”] in the Atlantic Magazine in January [2008] in which he says: The first thing we do is kill all the school boards, because what you need is the leadership of a Mayor in a city, and the Mayor is the single most important government official in the city, and you want the Mayor out there, responsible, accountable, aligning the budget with the mission, and standing before the city and saying “Education is our number one priority.”

So that, to me, is the right governmental structure and then the group of people you want to bring in to do the work, it’s got to be a group of people that has the mix of talent. If you choose them all from one side, if you have all managerial types with no educational expertise, that won’t work. By the same token, if you have all educators with no managerial expertise, who don’t get innovation, don’t get differentiation and talent, don’t get the use of incentives to reward excellence, and to make sure that incompetence, is dealt with. If those things aren’t a part of the equation, you’ll continue to get the results we’re now getting, 54 years after Brown [i.e. Brown v. Board of Education].

 

If a doctor went to sleep 50 years ago and woke up today, nobody would allow that doctor in a hospital to do surgery, right? But, what about a teacher?

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Predicting PTSD symptoms becomes possible with a new test

An algorithm may allow doctors to assess PTSD candidates for early intervention after traumatic ER visits.

Image source: camillo jimenez/Unsplash
Technology & Innovation
  • 10-15% of people visiting emergency rooms eventually develop symptoms of long-lasting PTSD.
  • Early treatment is available but there's been no way to tell who needs it.
  • Using clinical data already being collected, machine learning can identify who's at risk.

The psychological scars a traumatic experience can leave behind may have a more profound effect on a person than the original traumatic experience. Long after an acute emergency is resolved, victims of post-traumatic stress disorder (PTSD) continue to suffer its consequences.

In the U.S. some 30 million patients are annually treated in emergency departments (EDs) for a range of traumatic injuries. Add to that urgent admissions to the ED with the onset of COVID-19 symptoms. Health experts predict that some 10 percent to 15 percent of these people will develop long-lasting PTSD within a year of the initial incident. While there are interventions that can help individuals avoid PTSD, there's been no reliable way to identify those most likely to need it.

That may now have changed. A multi-disciplinary team of researchers has developed a method for predicting who is most likely to develop PTSD after a traumatic emergency-room experience. Their study is published in the journal Nature Medicine.

70 data points and machine learning

nurse wrapping patient's arm

Image source: Creators Collective/Unsplash

Study lead author Katharina Schultebraucks of Columbia University's Department Vagelos College of Physicians and Surgeons says:

"For many trauma patients, the ED visit is often their sole contact with the health care system. The time immediately after a traumatic injury is a critical window for identifying people at risk for PTSD and arranging appropriate follow-up treatment. The earlier we can treat those at risk, the better the likely outcomes."

The new PTSD test uses machine learning and 70 clinical data points plus a clinical stress-level assessment to develop a PTSD score for an individual that identifies their risk of acquiring the condition.

Among the 70 data points are stress hormone levels, inflammatory signals, high blood pressure, and an anxiety-level assessment. Says Schultebraucks, "We selected measures that are routinely collected in the ED and logged in the electronic medical record, plus answers to a few short questions about the psychological stress response. The idea was to create a tool that would be universally available and would add little burden to ED personnel."

Researchers used data from adult trauma survivors in Atlanta, Georgia (377 individuals) and New York City (221 individuals) to test their system.

Of this cohort, 90 percent of those predicted to be at high risk developed long-lasting PTSD symptoms within a year of the initial traumatic event — just 5 percent of people who never developed PTSD symptoms had been erroneously identified as being at risk.

On the other side of the coin, 29 percent of individuals were 'false negatives," tagged by the algorithm as not being at risk of PTSD, but then developing symptoms.

Going forward

person leaning their head on another's shoulder

Image source: Külli Kittus/Unsplash

Schultebraucks looks forward to more testing as the researchers continue to refine their algorithm and to instill confidence in the approach among ED clinicians: "Because previous models for predicting PTSD risk have not been validated in independent samples like our model, they haven't been adopted in clinical practice." She expects that, "Testing and validation of our model in larger samples will be necessary for the algorithm to be ready-to-use in the general population."

"Currently only 7% of level-1 trauma centers routinely screen for PTSD," notes Schultebraucks. "We hope that the algorithm will provide ED clinicians with a rapid, automatic readout that they could use for discharge planning and the prevention of PTSD." She envisions the algorithm being implemented in the future as a feature of electronic medical records.

The researchers also plan to test their algorithm at predicting PTSD in people whose traumatic experiences come in the form of health events such as heart attacks and strokes, as opposed to visits to the emergency department.

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