TEXTO

Engaging Doctors in the Health Care Revolution

  Despite wondrous advances in medicine and technology, health care regularly fails at the fundamental job of any business: to reliably deliver what its customers need. In the face of ever-increasing complexity, the hard work and best intentions of individual physicians can no longer guarantee efficient, high-quality care. Fixing health care will require a radical transformation, moving from a system organized around individual physicians to a team-based approach focused on patients. Doctors, of course, must be central players in the transformation: Any ambitious strategy that they do not embrace is doomed.

  And yet, many physicians are deeply anxious about the changes under way and are mourning real or anticipated losses of autonomy, respect, and income. They are being told that they must accept new organizational structures, ways of working, payment models, and performance goals. They struggle to care for the endless stream of patients who want to be seen, but they constantly hear that much of what they do is waste. They’re moving at various rates through the stages of grief: A few are still in denial, but many are in the second stage—anger. Bursts of rage over relatively small issues are common.

  Given doctors’ angst, how can leaders best engage them in redesigning care? In our roles in senior management of two large U.S. health care systems, and as observers and partners of many others, we have seen firsthand that winning physicians’ support takes more than simple incentives. Leaders at all levels must draw on reserves of optimism, courage, and resilience. They must develop an understanding of behavioral economics and social capital and be ready to part company with clinicians who refuse to work with their colleagues to improve outcomes and efficiency.

  To help health care leaders engage physicians in the pursuit of their organizations’ greater goals, we suggest a framework based on the writings of the economist and sociologist Max Weber, who described four motivations that drive social action (that is, action in response to others’ behavior). Adapted for health care professionals, these are: shared purpose, self-interest, respect, and tradition. Leaders can use these levers to earn doctors’ buy-in and bring about the change the system so urgently needs.

(Adapted from www.hbr.org)

TEXT

Howard Gardner: ‘Multiple intelligences’ are not ‘learning styles’ by Valerie Strauss

The fields of psychology and education were

revolutionized 30 years ago when we now worldrenowned

psychologist Howard Gardner published his

1983 book Frames of Mind: The Theory of Multiple

[5]  Intelligences, which detailed a new model of human

intelligence that went beyond the traditional view that

there was a single kind that could be measured by

standardized tests.

Gardner’s theory initially listed seven intelligences

[10]  which work together: linguistic, logical-mathematical,

musical, bodily-kinesthetic, interpersonal and

intrapersonal; he later added an eighth, naturalist

intelligence and says there may be a few more. The

theory became highly popular with K-12 educators1

[15]  around the world seeking ways to reach students who

did not respond to traditional approaches, but over time,

‘multiple intelligences’ somehow became synonymous

with the concept of ‘learning styles’. In this important

post, Gardner explains why the former is not the latter.

[20]  It’s been 30 years since I developed the notion of

‘multiple intelligences’. I have been gratified by the

interest shown in this idea and the ways it’s been used in

schools, museums, and business around the world. But

one unanticipated consequence has driven me to

[25]  distraction and that’s the tendency of many people,

including persons whom I cherish, to credit me with the

notion of ‘learning styles’ or to collapse ‘multiple

intelligences’ with ‘learning styles’. It’s high time to

relieve my pain and to set the record straight.

[30]  First a word about ‘MI theory’. On the basis of

research in several disciplines, including the study of

how human capacities are represented in the brain, I

developed the idea that each of us has a number of

relatively independent mental faculties, which can be

[35]  termed our ‘multiple intelligences’. The basic idea is

simplicity itself. A belief in a single intelligence assumes

that we have one central, all-purpose computer, and it

determines how well we perform in every sector of life. In

contrast, a belief in multiple intelligences assumes that

[40]  human beings have 7 to 10 distinct intelligences.

Even before I spoke and wrote about ‘MI’, the term

‘learning styles’ was being bandied about in educational

circles. The idea, reasonable enough on the surface, is

that all children (indeed all of us) have distinctive minds

[45]  and personalities. Accordingly, it makes sense to find out

about learners and to teach and nurture them in ways

that are appropriate, that they value, and above all, are

effective.

Two problems: first, the notion of ‘learning styles’ is

[50]  itself not coherent. Those who use this term do not

define the criteria for a style, nor where styles come

from, how they are recognized/ assessed/ exploited. Say

that Johnny is said to have a learning style that is

‘impulsive’. Does that mean that Johnny is ‘impulsive’

[55]  about everything? How do we know this? What does this

imply about teaching? Should we teach ‘impulsively’, or

should we compensate by ‘teaching reflectively’? What of

learning style is ‘right-brained’ or visual or tactile? Same

issues apply.

[60]  Problem #2: when researchers have tried to identify

learning styles, teach consistently with those styles, and

examine outcomes, there is not persuasive evidence that

the learning style analysis produces more effective

outcomes than a ‘one size fits all approach’. Of course,

[65]  the learning style analysis might have been inadequate.

Or even if it is on the mark, the fact that one intervention

did not work does not mean that the concept of learning

styles is fatally imperfect; another intervention might

have proved effective. Absence of evidence does not

[70]  prove non-existence of a phenomenon; it signals to

educational researchers: ‘back to the drawing boards’.

Here’s my considered judgment about the best way

to analyze this lexical terrain:

Intelligence: We all have the multiple intelligences. But

[75]  we signed out, as a strong intelligence, an area where

the person has considerable computational power.

Style or learning style: A hypothesis of how an individual

approaches the range of materials. If an individual has a

‘reflective style’, he/she is hypothesized to be reflective

[80]  about the full range of materials. We cannot assume that

reflectiveness in writing necessarily signals

reflectiveness in one’s interaction with the others.

Senses: Sometimes people speak about a ‘visual’

learner or an ‘auditory’ learner. The implication is that

[85]  some people learn through their eyes, others through

their ears. This notion is incoherent. Both spatial

information and reading occur with the eyes, but they

make use of entirely different cognitive faculties. What

matters is the power of the mental computer, the

[90]  intelligence that acts upon that sensory information once

picked up.

These distinctions are consequential. If people want

to talk about ‘an impulsive style’ or a ‘visual learner’,

that’s their prerogative. But they should recognize that

[95]  these labels may be unhelpful, at best, and ill-conceived

at worst.

In contrast, there is strong evidence that human

beings have a range of intelligences and that strength (or

weakness) in one intelligence does not predict strength

[100]  (or weakness) in any other intelligences. All of us exhibit

jagged profiles of intelligences. There are common sense

ways of assessing our own intelligences, and even if it

seems appropriate, we can take a more formal test

battery. And then, as teachers, parents, or selfassessors,

[105]  we can decide how best to make use of this

information.

(Adapted from https://www.washingtonpost.com/news/answer-sheet)

Glossary:
1. K-12 educators defend the adoption of an interdisciplinary
curriculum and methods for teaching with objects.

WHAT IS LIFE?

The magazine Philosophy Now asked two people, Tom Baranski and Courtney Walsh, to define what life is.

Tom Baranski from Somerset, New Jersey, believes that life is the aspect of existence that processes, acts,
reacts, evaluates and evolves through growth (reproduction and metabolism). The crucial difference
between life and non-life (or non-living things) is that life uses energy for physical and conscious
development. Life is anything that grows and eventually dies, ceases to proliferate and be cognizant. Can
[5] we say that viruses, for example, are cognizant? Yes, insofar as they react to stimuli; but they are alive
essentially because they reproduce and grow. Computers are non-living because even though they can
cognize, they do not develop biologically (grow) and cannot produce offspring. It is not cognition that
determines life: it is rather proliferation and maturation towards a state of death; and death occurs only to
living substances.

[10] Or is the question “What is the meaning (purpose) of life?” that is a real tough one? But Tom Baranski
thinks that the meaning of life is the ideals we impose upon it, what we demand of it. The meaning of life
is to: Do good, Be Good, but also to Receive Good. The foggy term in this advice, of course, is “good”; but
he leaves that to the intuitive powers that we all share.

There are, of course, many intuitively clear examples of Doing Good. Most of us would avoid murdering;
[15] and most of us would refrain from other acts we find intuitively wrong. So our natural intuitions determine
the meaning of life for us; and it seems for other species as well, for those intuitions resonate through
much of life and give it its purpose.

On the other hand, Courtney Walsh from Farnborough, Hampshire, defines life as the eternal and
unbroken flow of infinite rippling simultaneous events that by a fortuitous chain has led to this universe
[20] of elements we are all suspended in, that has somehow led to this present experience of sentient existence.
Animal life (excluding that of humans) shows that life is a simple matter of being, by means of a modest
routine of eating, sleeping and reproducing. Animals balance their days between these necessities, doing
only what their bodies ask of them. The life of vegetation is not far from that of animals. They eat and
sleep and reproduce in their own way, for the same result. So life is a beautiful and naturally harmonious
[25] borrowing of energy.

Yet we have taken it for granted. We have lost the power to simply be happy eating, sleeping, reproducing,
believing we need a reason to be alive, a purpose and a goal to reach, so that on our deathbeds (something
we have been made to fear) we can look back and tell ourselves we have done something with our lives.
Life has lost its purpose because we have tried to give it one. The truth is that we are no more significant
[30] than the sand by the sea or the clouds in the sky. No more significant. But as significant.

No matter what your race, religion or gender, when you first step outside your door in the morning and
feel the fresh air in your lungs and the morning sun on your face, you close your eyes and smile. In that
moment you are feeling life as it should be.

Adaptado de philosophynow.org.