Pacing Problems

It's been a little while since I gave an update on how my Health Literacy class has been going. In a word, it has been wonderful. The averages on the quizzes have been around 90%. Attendance is still somewhat spotty, but many patients will come to me on their own if they missed a class to make up the work. The patients are very willing to do the work during group, even when we're doing something kind of boring.

It's always more interesting to discuss what has not been going so smoothly, however. Tuesday was the first day all summer where we didn't finish what we were scheduled to in class. Our objective was to summarize a story about a patient's journey with HIV/AIDS. For you non-teachers out there, a good lesson goes through an entire "lesson cycle," which includes five steps:

My easel with a typical agenda
showing the lesson cycle.

1. Opening. You communicate the importance of the day’s objective and thereby engage the students.

2. Introduction to New Material. You model the new skill. This is abbreviated in my agenda as "I do."

3. Guided Practice. The students have an opportunity to practice the new skill in groups or pairs while I monitor their progress and provide feedback. Abbreviated as "We do."

4. Independent Practice. Students practice their new skill on their own so I will know if they have mastered the day’s objective. Abbreviated as "You do."

5. Closing. In my health literacy class, this usually takes the form of a journal entry reflecting on what we learned.

This way of planning a lesson was drilled into my head during my time with Teach For America, and I still use it for every one of my health literacy classes! Like some would say, I drank the Teach For America Kool-Aid. But like I mentioned, unfortunately, we didn't make it through all five steps of the lesson cycle on Tuesday. First of all, we didn't start class until 10 minutes into our allotted 45 minute time slot. Then the objective (summarizing a story) was just way too hard to fit into one class. We only got through the Guided Practice, and some people did not even finish that.

I never have been very good at pacing my classes so that what I have planned takes exactly the right amount of time. Usually, I err on the side of planning too much for one class (which I think is still better than the opposite situation, where you finish early and then don't know what to do with the students for the end of class). I'll never forget how I felt on my very first day in a classroom, in June 2007, at Scarborough High School in Houston. I was teaching ninth grade algebra in summer school, to students who already had an entire year of algebra but had failed their class. For my first lesson, I planned on reviewing how to solve one step algebraic equations (such as x+ 6=10). Imagine the horror I felt when I went through several examples, and was getting blank, confused stares back from the students. I tried to break it down as much as I could, explaining that to solve x+6=10, you had to first subtract 6 from both sides, but even that didn't make sense to them. That first day, I ended up having to teach them things that should be intuitive to ninth graders, like how a number minus itself equals zero. Needless to say, we didn't come close to getting through the lesson I had planned that day.

So here I am, more than three years later, and I still have not mastered the art of pacing a lesson. However, I'd like to think I've improved since my very first day as a teacher. I just need to remind myself what is and is not feasible to accomplish in a 45 minute period. Luckily, I've already planned on reviewing summary a couple more times, so all is not lost. The patients here will learn to summarize by the end of the summer!

So, This Is Hard

After my first day of actual teaching yesterday, I realized there will definitely be some unique challenges to working with the population at PSI. I want to start out by saying that I absolutely love working with them. The best part of my job is having the privilege of interacting with the patients here. They're a fun and rowdy bunch, which can definitely be a positive thing since it leads to thought provoking discussion and insightful questions about their disease. We will be facing our fair share of obstacles, however.

Two of the residents I teach have mild mental retardation. One has such poor vision that she cannot see the letters on the worksheet. One doesn't read a word of English, and can barely speak it. One decided five minutes in that she wasn't going to participate, but she didn't want to leave the room either and instead walked around loudly bothering the other residents. One proclaimed in class yesterday "I hate reading," to which I responded, "Well... this is a literacy class, so we're going to be doing a lot of reading."

Unlike teaching high school, I can't threaten the residents with consequences like detention or a deduction in their participation grade. The residents attend my class completely by their own free will, which is amazing. Also unlike teaching high school, about 10 minutes before class was done there was a large group of people waiting to cross through the area where I teach to go outside and take a cigarette break. Needless to say, this caused quite the distraction when they walked through my classroom, right as the residents were working on their quiz for the day. This 3:00 smoke break will happen at the end of every one of my classes.

Our objective for the day was to be able to read and answer questions about a paragraph on HIV/AIDS drugs. The average reading comprehension score on their diagnostic was a 65%. Amazingly, the average quiz score was an 86%, meaning they grew 21 percentage points in just one class! (If I discount the scores of the 2 residents with severe disabilities, the average jumps to a 93%). I'm so incredibly proud of each of my students. Hopefully their reading skills will continue to grow as the summer progresses.

My First Class

I put a sign up sheet on the door to my office, made an announcement to all of the PSI residents about my class, and crossed my fingers that people would sign up. As I was sitting in the office planning the final details of my first class, I could hear a group of them congregating outside my door.

"What's this sign up sheet for again?"

"It's the class that white girl was talkin' about!"

"Oh yeah! We get a certificate at the end!"

I couldn't help but laugh to myself. The residents I'll be teaching already remind me a lot of my students in Houston. For one, being known as "that white person." And secondly, how excited the residents got about receiving a certificate for my class. No matter your age, external rewards seem to be a good motivator. Hopefully in time they will start to value what they're learning in my class to become internally motivated. As it turns out, there may be a legitimate reason the residents (most of whom are middle-aged) remind me of my teenage high school students. Another member of the education staff of PSI told me that when addicts stop using drugs, they remain "stuck" at the same developmental level they were at when they started using. For many of the residents of PSI, this was when they were in high school.

I ended up getting over 20 people to sign up for my class this past Thursday, which I viewed as a huge success. The first item on the agenda was introductions. I reminded them of my name (I haven't been referred to as 'that white girl' since, I believe) and defined 'Health Literacy' as the ability to read and understand health information. Then I gave them their pre-test for the medication unit. I thought there was a possibility some would walk out when I announced I was giving a quiz, but they all went along with it! Afterwards, I had them sign a contract saying that they would attend class and work their hardest. I also had them write their first journal assignment, in which they described what they wanted to learn from my class, their goals, and anything else I should know about them. All of the residents gave very thoughtful responses and to my delight, want to learn about some of the topics I was already planning on covering.

To wrap up class, I told the residents they could ask me anything they wanted. One woman asked me if there were any differences between women's and men's health, besides the obvious anatomical differences. I told her that in fact, many diseases have different symptoms, prevalence, and course in women and men. Next, a transwoman raised her hand and asked, "How does this affect me, since I have male chromosomes, but women's hormones?" I was so impressed by this intelligent and insightful question, and told her the truth - that I didn't know, because there was not much research done on trans health. This led to a great discussion of the biases that transpeople and people living with AIDS face, and how society did not respond to the AIDS epidemic until upper-class and straight people were diagnosed. The residents got so fired up by the discussion, and I really want to include some reading assignments on social justice later on in the curriculum.

Overall, great first class!

Why Health Literacy?

I thought I'd share with you how I became interested in the topic of Health Literacy. For those unfamiliar with the term, health literacy is the ability to understand and interpret health care-related information and services in order to make good decisions and adhere to treatment. Better health literacy is known to be correlated with more positive health outcomes in patients living with AIDS, like the residents of Project Samaritan. In fact, one study found that the number one determining factor in AIDS outcomes is the level of health literacy! (AIDS outcomes meaning the amount of virus particles in your body, survival time after diagnosis, etc.) I very strongly believe that health care is a right, and it is abhorrent that one's education level should determine one's quality of health.

This brings me to the reason I became interested in health literacy in the first place. Before I enrolled in med school last fall, I was a high school teacher for 2 years with Teach For America (http://www.teachforamerica.org/). TFA is an organization that recruits recent college graduates to teach in low-income schools for two years, with the goal of closing the achievement gap. Learning that only 1 in 10 children growing up in poverty will graduate from college, or that the average student in a low-income community performs as well as an eighth grader coming from a higher income area, made my blood boil.

After graduating from college, I moved to Houston, Texas where I taught ninth grade science at Jefferson Davis High School (see the picture of me in action in my classroom). About 90% of the students at Davis qualify for free or reduced lunch. Many of my students were several grade levels behind in math and reading. I also began noticing that my 15 year old students had health problems that I had thought were predominantly disease of older people - high blood pressure, cancer, type 2 diabetes. It was then that I started making the connection between poverty, education, and health, which put me on the path to medical school.

As a Teach For America alum and a medical student, I have a particular interest in the intersection between health care and education. Teaching my Health Literacy class this summer is bound to be an incredible experience. I can only hope that my students will learn as much from me as I know I will learn from them.