Upon reflecting, the greatest limitation I can see is that most principals simply don't have the extensive knowledge that is required. Personally, I have been out of classroom teaching for over 15 years, so my knowledge of curriculum is no longer detailed, nor am I credible in this. Secondly, considering the medical model: in the common doctor/'healthy' patient relationship, there is minimal ongoing interaction and relationship. There is certainly trust, but that is generally based on the doctor's reputation, qualification and practice. The principal/teacher relationship has ongoing, daily interaction, communication and relationship at a deeper level that the medical model may not take sufficiently into account. 

This "medical model" analogy resonates with me. I find that I place the burden on myself of feeling feel like I should have the answers to every challenge, concern, or issue that we have in our school. I know myself well enough to know I do not have all of the answers and at times this keeps me from visiting classrooms. Changing my paradigm on classroom walkthroughs will help me overcome the "medical model" mindset that I have. 

Some of the major limitations I have seen with the medical model is it puts pressure on the instructional leader to have all of the answers in order to diagnose the problems. It is also challenging to get conclusive evidence for diagnosis when you are only able to observe what can be seen, heard, or experience. So much of the challenge lies in the decision making of the teacher which is not observable. 

The medical model assumes that there is a problem that needs to be fixed. It can appear to be negative and sometimes punitive to the teacher being observed in that it starts out with the observer identifying deficiencies and shortcomings in their work. 

I see two key drawbacks with the medical model. The first one is what Justin identified as our own, you know, as principals or School leaders, our own limitations, in terms of curricular knowledge. It really is impossible to walk into most classrooms and know curricularly, exactly. What's going on. What should come next? What should have preceded it, but I think the other the other concern that would have with the medical model is that it doesn't necessarily promote a lot of teacher efficacy, you know, if the teacher is relying on that, medical model feedback relying on that accurate diagnosis and the prescription, then then that's just it. They're reliant on someone else to do that the school administrator to do that and that's not a model for growth for that teacher.

Certainly if there are gaps in a teacher's pedagogy or you know,
know classroom instructional practices, that's something that we want to partner with an address, but also long term. We want that growth to come from the teacher so that they are able to recognize that change in behavior. They're able to, you know, recognize future challenges and able to grow from it. I think as an administrator, we always want to be a partner with our teachers, but we also want to instill in them that sense of autonomy that sense of efficacy and that sense that they also have a lot of control over their own growth and learning. I want to be a learning partner with teachers. I want to be part of that discussion. I want to ask them questions. I want to lead them to the right place, but what I might prescribe or what might work for me in my personal style may not work for them. And I've seen that in a lot of different classrooms, you know, things even things. Even as simple as a teacher's particular sense of humor might work really well for one individual but might totally fall flat [with another].

The Medical Model is limited to just the leader's perspective & experience. It is rigid and conforms to the leader and not to where is should, the teacher. 

The Medical Model of feedback is very time consuming as well as intensive for an instructional leader. This leads to leaders being less likely to provide the feedback. In addition, it can lead to very close minded, subject dependent, or skill dependent feedback, not improving teaching as a whole and building capacity to take the knowledge into other areas within the classroom. It can feel very nitpicky and therefore teachers will begin to not hear the feedback to grow. In addition, just like with a doctor who only looks at lab reports, instead of having a relationship with a patient and conversation, you will miss something and potentially get the diagnosis wrong. The more time you spend in the classroom at a variety of times and having conversations, the better the feedback and support you can give teachers. 

It's an examination of breaking down the patient, but in this case the teacher. it takes a lot of time and knowledge for this model. 

Medical models often follow a simplistic, "if-then" approach. Yet, classrooms situations and the art of responding to them have a wide variety of less unpredictable causes and effects than the science of medicine. 

You should not enter the classroom assuming the role of doctor and attempt to diagnose and treat the problems you see. Instead we need a more collaborative and curious approach where teachers and educational leaders are working together, building trust, and supporting students as a team. 

I think you hit the nail on the head, in the video, Justin about the limitations of the medical model, and I say that because of the comment you made about having to know so much to be able to make an accurate examination and accurate diagnosis and give a valuable prescription that will help the teachers improve their practice.

I mean, you'd have to be like the top expert on all things, everything. And we know that principals are very smart. Assistant principals are smart, too, but we don't know everything. And so it, the medical model kind of ties our hands behind our backs because there are things that we pretend that we know, or we may want to put out the image that we know these things, and a lot of times, we don't really even know how to help the teachers.

There are some challenges that come up. We know how we would have handled them. But you have to really know your teachers to know how to help them grow. And then on top of that, one of the big limitations, I think of all of it is that the mindset of not just you, but the mindset of the teacher, the teacher may not even feel that they need to grow. They may feel that they've got it all together. They may feel like there's nothing wrong. So the medical model could cause some resistance, some reluctance has resistance from the teachers to adapt to your what your suggestion or prescription is. A matter of fact, if you teach if you talk one subject, as a teacher, but you're doing a walkthrough with a teacher, that teaches a subject that you did not teach. The first thing, the teacher is going to say is how do you know you've never taught my subject?

One thing that comes to mind is that snapshot doesn't give us the whole picture. So if I was to diagnose something without all the background knowledge of what was happening I may be off the mark when trying to prescribe a better option to my teacher. This will harm the principal /teacher relationship.

The medical model seems to recommend directive feedback. Directive feedback should be sparingly used as it diminishes a teacher's capacity for learning. It also becomes something done to not done with the teacher. Finally, you may get compliance, but rarely will you get commitment. The teacher will do it until you leave the room, or do it when you enter the room, but it won't be done regularly or consistently. 

I know that I am uncomfortable using a "medical model" feedback with my teachers. I feel that teaching is a very personal thing and that we often approach things in a different way. It seems that we are trying to make everything into a problem instead of working from an area of strength for that individual. 

One limitation of the Medical Model is that instead of focusing on instructional practices we may lean toward focusing on content. Administration tends to have a more closed minded or narrow view of what is happening because they are looking for specific problems to diagnose instead of the whole picture of what's going on in the classroom. 

Medical Model Limitations

I think one draw back is its impact on the observer. As you shared the medical model requires extensive knowledge and that may keep a principal from entering the classroom because they do not feel they have the expertise in math, let's say, to provide feedback to a math teacher. The medical model also leads you to think that one prescription will solve an issue.

Classrooms are complex places a may require more than one "examination" to gain understanding. Missing in the model is input from the teacher to get an understanding of what drove instructional decisions. The loss of trust can be a huge side effect from following the medical model, as it changes the dynamic between the teacher and principal. People may begin thinking that you only see their work through a deficit lens, always needing some kind of prescription to get better. 

The medical model doesn't allow for much teacher input. It expects the administrator to have all the answers, when the reality is administrators can't have all the answers all the time. It also gives off the perception of things being done to the person instead of with the person which can make them much more resistant to that change.

One limitation of the medical model in regard to instructional leadership is that there might not be the proper follow up to see if there is improvement. The "disease/cause" of the issue may not be something that can be fixed. We have to be careful that there is the proper conversation happening. We cannot talk at our staff, we need to talk with our staff. 

One key limitation of this model is that walkthroughs provide only a brief snapshot of the classroom environment, capturing a moment in time rather than the full complexity of instructional practices. Achieving the level of detailed knowledge required to complete the Medical Model with fidelity can indeed feel overwhelming, particularly when curriculum requirements and instructional strategies are constantly evolving.

As instructional leaders, it’s natural to feel the weight of these challenges, which can lead to self-doubt or a sense of focusing on gaps rather than successes. 

You are basing your feedback on a limited sample of evidence and often it is inaccurate; or you don't know what happened before or after or what the teacher's intention was so your diagnosis is wrong and it is insulting to the teacher; or worse, you don't even understand what is happening because it is not an area you are familiar with and so your "advice" is useless. 

Teachers often take the feedback as criticism, when we attempt to cover it all. The feedback is processed this way due to the fact we see a small snapshot of the total instruction and are missing details. We may not have the expertise in the particular content area and that can be seen from the teacher as belittling. That being said, good instructional practices have less to do with content and more do with what is actually occurring and how the instruction is being delivered.

We can see what the students and teachers are doing. What is invisible are the motivation, thoughts and plan into the decisions the teacher and learner are making. It seems that's why it's important to ask questions of both the teacher and the students about how they are processing and engaging with the experience. 

Some of the major limitations I have seen with the medical model is it puts pressure on the instructional leader to have all of the answers in order to diagnose the problems. It is also challenging to get conclusive evidence for diagnosis when you are only able to observe what can be seen, heard, or experience. So much of the challenge lies in the decision making of the teacher which is not observable. 

Some of the difficult parts about the medical models, like you said, you as an individual, as a principal, I don't see how you can have extensive knowledge on every single grade level, and it's usually not possible. So you'd have to be an expert, every grade level to be able to diagnose and prescribe you know, what needs to go on, what they should be doing. So that's where I see the issue. The problem with the medical model is that as an individual? I don't think there's anyone who has either taught every grade level or can can rattle off all of the standards for each grade level. So that's where it becomes difficult.

Since the "Medical Model" requires the instructional leader to be an expert, this model can only work with a certain type of teacher. An instructional leader may get by as an expert when supervising novice teachers but it will become harder to give meaningful feedback to stronger and more experienced teachers. 

Limitations of utilizing the "medical model" of feedback in walkthroughs-

• I don't know everything - assumes that I do
• My observation is limited - did not observe what happened yesterday or 5-minutes before I entered the room
• I can't read the teacher's mind - so I don't know what they are thinking or why they are making the choices/decisions that they are implementing in the classroom
• Undermines the capacity and autonomy of teachers - as if leader is "all knowing" 

This model seems that you have to be an expert in all areas...and that it is the fix to the problem. Never addresses the root of the issue is only looking to cure it fast 

Misdiagnosis is one of the limitations is common with medical model. Without having enough time to observe—being that we are in the classroom for 15-20 minutes—without having enough, time to adequately try to diagnose, we maybe misdiagnosing what the real issue is and offering suggestions and recommendations based on a flawed diagnosis, which then will not improve teacher practice.

What are the major issues? I see what the medical approach to walkthroughs is the insinuation that the teacher is somehow sick and needs medical attention. Now, I guess I could look at it from the approach of wellness check per se. But again, it's kind of going into it. Like there is something wrong with this particular teachers practice that I need to somehow fix and that is demeaning and it's the wrong approach.

When going into a classroom to immediately look for what should the teacher be doing instead of what is the teacher doing puts a focus on the negative instead of the positive areas. When using this approach in conversations with the teacher, they may feel criticized and less likely to change. 

Visible - instruction, student engagement, monitoring

Not visible - planning, preparation, data analysis, needs of student groups, relationship building 

The most immediate problem with the medical model is that the knowledge base from the observer must be so vast in order to help make an accurate diagnosis. And something not mentioned in the video is the idea of "sample size". If we are in the classroom for a brief period of time, are we truly seeing enough/taking in enough "information" with which to compare to our knowledge base? A small sample size or "N" (in this case, time) may not yield the data we need to inform a diagnosis. And everything that follows from there is based on inaccurate information, all the way down to the prescription. Sort of like "fruit from the poisonous tree", to use a legal term for evidence collected improperly, and does not become admissible in court. 

We would not necessarily provide teachers with many options to choose from in currenting the instructional strategy. We would place limits on their capabilities. 

Limitations of the medical model as an approach to instructional leadership - -that assumes there is one "best way" to teach something-there are so many variables to student learning - it is hard to pin down "the broken leg" in order to fix it...-the medical model doesn't take into consideration the teacher's autonomy 

Medical Model gives us more tunnel vision on one specific part of the walkthrough. We have to focus on 1 aspect of the classroom, diagnose the 1 thing wrong, and then prescribe something to make that 1 thing work. We need to be looking at the whole room, the whole teaching experience, and all the students. Take into account more factors than just that short snapshot of our quick walkthrough. 

While I am sure that there might be many different limitations and drawbacks to the medical approach, the main one I see is the limitations of the educational leader or "doctor". I know that some people will tell you that they know everything they need to know and have mastered everything they need to master by the time they become a leader, but the truth of the matter is that they are wrong. If and when we stop learning new things and looking at things from a different prospective we have failed. We can not expect our teachers to be life long learners and change if we are not willing to do the same thing. 

A drawback is that there is an assumption that something is wrong, or worse, everything is great. It could potentially create an atmosphere where teachers always feel as though they are being judged and could become defensive (ie. - You just didn't see it in this moment). Conversely, no feedback could create a sense that all is perfect, and no adjustments are needed. 

I think the challenges of using strictly the medical model or as you said, you would have to be an expert on the various subjects the teachers teach. You want to prescribe something to help them further their practice to diagnose what they're doing wrong. However, if you're working with the staff and you have 40 people on your caseload for observations, the medical model is not really the best model. So, you know, using evidence driven feedback, as you said, which I think it involves a lot of artifacts and other things than just the walkthroughs and the observations will help.
Help get to know teacher practice, because we want to look at what they're doing in the classroom via these artifacts as well. So, we don't want to compare principals to doctors and teachers to the patients.

The medical model has its drawbacks. As admin when we do our regular rounds of informal observations we only see a snip-it of the whole. Feedback is given based off of a moment of that time, which may not necessarily change teacher practice . When doing formal observations , these are moments of time that we observe the teacher /students at their best due to planning done before the observation. Feedback during these formals is only giving for a lesson / moment that may not truly depict day to day teaching, student learning and lesson planning. 

One of the issues that I would say with using the medical model, as the, as a tool for the classroom, walkthroughs, would be that in that model. I'm assumed to be the expert. So when you go to the doctor, the doctor checks you out, they prescribed whatever medication to fix, what ails you, but again, they are the expert in that situation. So whenever I go into a classroom, I'm not the expert of that that content I know good teaching when I see it. I can give some tips that can they can help out but I'm they're assuming that my teacher is the expert. So that is that to me. That's the difference of what the medical model would have.

I think the challenges of using strictly the medical model or as you said, you would have to be an expert on the various subjects the teachers teach. You want to prescribe something to help them further their practice to diagnose what they're doing wrong. However, if you're working with the staff and you have 40 people on your caseload for observations, the medical model is not really the best model. So, you know, using evidence driven feedback, as you said, which I think it involves a lot of artifacts and other things than just the walkthroughs and the observations will help.
Help get to know teacher practice, because we want to look at what they're doing in the classroom via these artifacts as well. So, we don't want to compare principals to doctors and teachers to the patients.

In simply using the medical model, one of the biggest challenges I see is gaining teacher buy-in. By coming in and assessing what is wrong, we create an uncomfortable relationship with the teacher. They don't see us as allies, but rather as enemies or a nuisance, at best. Another challenge is that we don't have all of the knowledge necessary to diagnose every class and every teacher. Our limited knowledge can create credibility issues with our staff. By creating this unstable relationship with teachers, we will not be able to get them to shift their practice because they will not be invested in the change. 

To observe teacher practice and have meaningful conversations about what we see the students experiencing in the classroom. 

The medical model assumes that we have expertise to prescribe what the teacher needs exactly to close the gap or fix what’s wrong that you have observed. Unfortunately, what you observe in your walkthroughs was only be a symptom of a much bigger issue. This model does not take into account the expressed needs of the teacher or working with the teacher to figure out what they need and what supports they may need, beside a quick fix from you.