Monday, August 31, 2009

The Need for Qualified Hope in Retention

Two weeks of illnesses, deaths, funerals, anniversaries of deaths and coaching parents who like me had lost a child had put me in a funk. Even the numerous requests to give talks, workshops and retention audits did not lift my spirits quite enough it seemed. But then I read Jerome Groopman’s book The Anatomy of Hope which somehow made it into a clearance for a dollar table at Barnes & Noble. In the book, Dr. Groopman, an oncologist and the Recanti Chair of Medicine at Harvard discusses the concept of hope and that led me to realize there is an aspect of retention and service that is too often not included in the literature or consideration. There is a strong emotional aspect to retaining a student that is extremely important. It may even be the most important aspect finally in whether or not a college, university or school will retain a student.

The emotional aspect is discussed in articles on ROI and Customer Service Factors and the Cost of Attrition as a significant factor in understanding student emotional considerations in applying to and staying at a college. This is presented in the section on affective roi. Affective ROI deals with feelings, the student’s attachment to the school. In it simplest consideration, the student calculates whether or not he or she feels as if the institution is returning the emotional investment being made into the school. The calculation deals with social equity Do I feel I at least a balance of investment I am making coming back to me in care and concern for me as an individual”? The affective focus also considers the student’s perception of the value of being associated with the college.

There is also the student’s concern with whether or not I feel I am valued and important to the school beyond the tuition I am paying. This is also expressed in statements such as “All you care about is my money” and “Hey, I pay your salary”. Heard those? Then you heard core affective roi concerns of a potential dropout.

The affective roi is a crucial emotional component that the student must appreciate positively from the interaction with the college if he or she is to stay. So how do you help form appreciations of caring, valuing and social equity? These simplest indicators and expressions include such simple things as smiling at the student, greeting him or her, interrupting what one is doing when the student needs help, being there for office hours, offering additional help and certainly listening and then helping. The college must do all it can to make the student feel as if it cares about him or her as a full individual.

The sense of valuing is of primary concern. It is something I learned more about while reading Dr. Jerome Groopman’s book. The first two lines in the book are

Why do some people find hope despite facing severe illness while other do not? And can hope actually change the course of a malady, helping patients prevail

I have often spoken and written and spoken about students as patients and we in higher education as doctors. Like medical patients, students come to us to find out what they need to do to get better, stronger, more intellectually and professionally healthy. We prescribe them the medicines of books, lectures, training, homework, papers and here and there a placebo quiz that we believe will make them more fit.

But we like medical doctors have our flaws. We are taught an area of expertise in a discipline as are medical doctors. We become sociologists, engineers, historians, educational curriculum experts, biologists, physicists, even neurolinguists as medical colleagues become orthopedists, oncologist, pediatricians, and neurologists. They and we even specialize within our specializations in similar ways – an historian focusing on the first two months of the French Revolution like a surgeon specializing in the left hand with expertise in the phalanges (yes they exist).

So, we as our medical colleagues know a great deal about our area and focus on the issues involved in that specialization. We listen to students about the same 18 seconds doctors do before we are ready to give an answer from our discipline. And we even have our Dr. House’s as shown by a note on a faculty office door. The note stated “I do not keep office hours because I am too busy but if you need to talk to me, you can try to callme.” We also have our Kildare’s, Marcus Welby’s, Hawkeyes and even a Dr. Cox or two.

Keeping Hope Alive In his book, Groopman explores the very valuable role of hope in the success of patients getting better. He finds that some patients have none and they seem to die more than those who do have at least some active hope. The ones with hope believe they can beat the cancer and often undergo painful treatments because after hearing all the risks and discomfort, they still believe they might work. They might allow for another extra year or even full remission. He also discusses patients an experiment at Baylor College of Medicine in which patients who had arthritis in the knee were led to believe they had surgery to correct it although they didn’t. They were given a placebo surgery without any arthroscope being used; just four small cuts where a scope might have been inserted. Their belief they had surgery allowed them to recover use of the knee without pain without the corrective procedure. The four small cuts along with being informed of the benefits and issues involved in the surgery created hope and belief.

An Bicycle of Qualified Hope in Action The hope the surgeons created made me recall a student who attended Briarcliff College on Long Island. This student did not have a good preparation for college either in his studies, or his intellectual development. He had remedial/developmental needs in basic areas like writing, math, even reading. But he met an admission’s rep who laid out an full program of developmental courses an challenges he would face and overcome. Then she provided him the longer course and goal of graduation. She made him believe he could do it. With dedication, work and more work he could succeed. He was given a clear shot of what I call qualified hope. That’s qualified hope not blind hope.

He was not told by the rep “Sure you can graduate and we are here to help” in a way similar to some doctors trying to boost the sprits of a patient even if there is a minor chance the treatment might work. Sort of like the doctor in Monty Python’s The Meaning of Life telling a person who lost a leg to a tiger “Oh, it’ll grow back. A couple days of rest and you’ll be right as rain.”

No, this student was told what he would have to do, what the treatment protocol demanded if he were to have a chance to graduate. He was told what he hads to do and what we would do. He was given qualified hope. He would have to work hard, do all his assignments, take developmental classes, ask for and get extra help outside of class when needed, not miss any classes and he could have a possibility to graduate. No guarantees but we will be there to help.

He believed the rep and the people he met at the College so he developed faith in the prognosis. When he needed help, he got it. When he needed to be told he was not doing something correctly, he was told. And when his car broke down and he missed a day of classes, he was called to see where he was and what the problems were. We stayed in touch and continued a running prognosis with cures.

That phone call boosted his trust in the college. His trust that the school really did care and would be there for him. If we called when he missed a class, we were letting him know that he really was important. But his car was dead. He didn’t have the money to repair it. He live twelve miles away. But he had faith in the college. This student trusted that Briarcliff did care and would live up to its promises. So he turned to his qualified hope and a bicycle with full qualified belief that it would get him the twelve miles back and forth. No mean feat on Long Island roads and highways.

And he rode that bike to college every day no matter what the weather. He even rode through a snowstorm that had shut the school because to get to an 8 o’clock class he had to leave before we could announce the decision.

And was he angry?

No. He wasn’t. He just asked if he could stay in the library and read until the storm stopped. Since we were there anyhow, why not? We also made sure he got some hot coffee to warm up, brought the bike inside and told him how amazed and proud we were of him. Almost as proud as when he graduated.

Yet other students who had many benefits of a good high school, a reliable personal car, came from a well to do family drop out of colleges and universities every day. Why? Not lack of skill.

Lack of hope or being given false, unqualified hope.

Instilling Hope from Within We can all instill hope, qualified hope in our students. How? By providing a clear picture of a possible future and how it can be achieved. Even if the path is hard arduous and required extra work and plodding through. They need to know what to expect. As Dr. Groopman does not hide the fact that chemotherapy can be grueling and even painful to his patients who will need to decide what their course of action will be, we need to let our patients, certainly our weaker students know what the academic therapy will entail so they can make a decision that is right for them As an oncologist would want a patient with a small window of success know what is ahead and let them decide if they have the hope and belief they can prevail, we need to do that with students who are in need of knowing.

Oncolgists know that some patients will decide to forgo the chemo knowing it likely will not produce enough benefit and accept their fate, so some students really should so the same. Or as patients can choose between different doctors and courses of treatment according to their levels of strength and hope, so we should do with students who we know will likely nor benefit from our college but might do okay within another. Just as it does a patient with an untreatable tumor for example false hope, it does a college no good to accept a student who will soon drop out. Sure it may help a rep meet a quota but it only adds to the next goals for admissions since that drop out will need to be replaced. (oh don’t tell me you don’t have quotas for reps. Call it what you will but we all now people are evaluated on numbers!)

And one more thing. We have to also have informed hope and belief in our selves and our schools. We must believe we can do a good job of helping others if we are well prepared and concerned. As Groopman writes

I learned that it takes much more than mere words to communicate information and to alter affect…I try hard to let patients read in my eyes that there is true hope for them. …for a physician to effectively impart real hope, he has to believe in himself. ..

But I assert that he (the patient) needs to know a at least minimum of amount of information about his diagnosis and the course of his problem; otherwise. His hope is false, and false hope is an insubstantial foundation upon which to stand and weather the vicissitudes of difficult circumstances. It is only true hope that carries its companions, courage and resilience through. False hope causes them to ultimately fail by the wayside as reality intervenes and overpowers them. (P. 209-210)




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