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  • Writer's pictureBruce Cummings

Word of the Day: “Shibboleth.” Or, What Do Eliminating SAT’s and Clinician Burnout Have in Common?

Most if not all readers of these OWS blogs are college graduates and no doubt recall with trepidation (or worse) sitting through the SAT exam in high school. In recent years, a growing number of colleges and universities have dropped the once universal requirement for SAT (or ACT) scores as part of the admissions process based on the reasonable belief that standardized tests heavily favored white, affluent students. Therefore, critics said, the continued use of such tests militated against kids from disadvantaged backgrounds getting into top schools. In the absence of standardized tests, high school grades, the college admission essay, teacher recommendations, and extracurricular activities assumed greater significance in the admissions process. Certainly no one could deny that kids from socio-economically advantaged backgrounds generally did better on SAT’s than did kids coming from disadvantaged zip codes, whether urban or rural. The resultant conclusion: eliminate the test, increase equity.


It turns out the conventional wisdom was wrong. Very wrong. In brief, colleges could and did use the SAT ‘s to find — and would actively seek out — promising students from disadvantaged backgrounds even if their SAT scores lagged their more advantaged counterparts in suburban high schools. By taking away the SAT’s, it became harder for bright disadvantaged students to stand out. For more about this counterintuitive finding, take a look at an excellent, well researched article by the New York Times education reporter, David Leonhardt.


"Shibboleth" within Hospital and Healthcare Systems


One of my fav words is “shibboleth”, a Hebrew word meaning a cliche, chestnut, or truism. I’m not Jewish and I don’t use it very often but from time to time “shibboleth” deserves to be trotted out because it just seems the most appropriate label to attach to a widely held if erroneous view — for example, the much (but erroneously) maligned SAT.


We are all familiar with and often repeat conventional wisdoms or truisms — shibboleths — including within hospital and health systems. For example: “patients come first!” [I no longer believe that. Rather, for executives, our people need to come first. Patient care is what hospitals deliver and without patients there would be no need for hospitals or group practices. But now there is extensive research showing that continued self-abnegation sets one up for future health and/or relationship risks.] Or, “rounding is key to good morale”. [Actually, the latest evidence shows that the typical rounding done by leaders in nursing units is not only ineffectual, it breeds cynicism.] Once upon a time, evidenced-based medicine and clinical decision-support tools were widely derided as “cookbook medicine” to be assiduously avoided by, you know, any competent clinician. [Guess what we now know underpins both avoidance of hospital-acquired conditions as well as serving as a key to successful value-based care arrangements?] And finally, this emerging shibboleth: “everyone is burned out because it’s an inevitable part of life (or at least one’s worklife)”. [Nope. Burnout is the response in an individual to issues in the workplace. The problem is the work, not a lack of resilience on the part of the worker. My colleague, Paul DeChant, MD, MBA and I often observe the implications of this mistaken belief as too many hospital leadership teams default to expanding wellness program offerings rather than redesigning noisome workflows and reimagining leadership practices.]


Moral of the story: treat conventional wisdoms — shibboleths — with heavy doses of circumspection.


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