What does helping students learn to read have in common with saving lives in hospital intensive care units? A simple but important concept that allows both to be more predictable.
For the last five years, I have been coordinating a tutoring program for students who are having difficulty learning to read. Students from kindergarten through 5th grade are referred to the program by their classroom teachers and receive instruction for 20 or 30 minutes to learn decoding skills as well as vocabulary, reading comprehension, and writing. Instruction in decoding skills develops the ability of the student to read words quickly and accurately, which supports reading comprehension. We teach eight of these decoding skills, beginning with learning the sounds of the letters and continuing on to strategies for decoding multi-syllable words.
About two years ago, I became concerned because some of our 4th and 5th graders were not making adequate progress in reading comprehension, and when they read orally, their decoding was weak. Upon further investigation, it turned out that they were not proficient in one or more of the decoding skills. Once we taught them the skills they needed, their comprehension improved.
While wrestling with how to ensure that other students would be proficient decoders long before the 4th grade, I read an article in The New Yorker by the surgeon Atul Gawande that gave me insight into my dilemma. The article described a problem in hospital intensive care units where a recovering patient develops an infection because one or more of the lines supplying food or drugs is contaminated. Such infections can be fatal and although there has long been a procedure for insuring that lines are sterile before and after insertion, the fidelity in doing the procedure depended on the memory of the I.C.U. staff. Then in 2001, Dr. Peter Pronovost of Johns Hopkins Hospital developed a checklist for inserting lines into patients, and it was implemented in one I.C.U. and monitored for 27 months. The results were hard to believe—the line infection rate went from 11 percent to near zero, and an estimated eight lives were saved. All from faithfully using the checklist when doing a line insertion—rather than relying on memory alone.
From the I.C.U. to the Classroom
After reading this article, it occurred to me that although we do in-depth assessments twice a year for comprehensive reading skills, in teaching decoding we were depending on the memory and judgment of each tutor to determine when the student was proficient. But if we had a decoding checklist that included a quick assessment for each skill, I thought, maybe the students would have a better chance of becoming competent decoders in a shorter time and long before the 4th grade.
Fortunately, reading researchers have developed assessments that measure when a student has mastered a particular decoding skill, so I could incorporate these into the checklist. A typical example is checking for proficiency in pronouncing three letter words. The student reads out loud from a list of words and must accurately pronounce 50 words in one minute. Similar assessments are included in the checklist for three-letter nonsense words, words ending in silent e, sight words, etc. Each assessment takes less than five minutes. Once a student passes the assessment, the tutor checks it off the list and moves onto the subsequent skill.
We started using the checklist last school year. In previous years, of the 1st and 2nd graders who were in our program at the beginning of the school year, less than 25 percent achieved grade-level proficiency in reading by the end of the year and were exited from the program. Last year, with 40 1st and 2nd graders in the program, the exit rate was 45 percent.
Students were taking less time to acquire better decoding skills, which in turn may have helped them to further improve their reading skills in their regular classroom. And in tutoring sessions they were able to spend more time on comprehension and writing.
To keep track of the decoding skills that had been mastered, each student also had a chart in his or her folder where their progress was recorded. An unexpected benefit was that students were excited to see that they had mastered a skill and were eager to tackle the remaining skills. We will continue to use the decoding skills checklist in our program and monitor the results, but it is still a work-in-progress. However, one of the best outcomes so far is that tutoring has become something students look forward to.