On September 9, a breast cancer diagnosis shattered my plans for the new academic year. At the moment I heard the words spoken by the radiologist, my vision of the future simply dissolved. Later in the day, as my surgeon described the treatment plan, I was thinking about how it would affect me, my family, and my work at Simmons College. With barely any time to consider it, I made the instinctive decision to live my new future publicly, sharing my experience with the Simmons students, professors and staff in a real-time fashion. I am convinced this was the right decision for me.
Why I arrived at that conclusion so quickly is, I think, self-evident: I am president of a university that has an all-women's undergraduate college, graduate schools serving women and men, and a culture that emphasizes gender equality and celebrates diversity and inclusion. In this environment, how could I imagine maintaining a leadership role while combating a challenging disease in secret? Further, how could I not share my new and evolving learning about an affliction that affects 12 percent of the women in the United States? I could not. I would live this battle publicly.
Each week, I write to the Simmons community about things that are on my mind; it has become the natural way to share my breast cancer journey, and I have found the response to be overwhelmingly supportive. If I had a moment's hesitation over my decision to go public, it faded quickly once I recognized the opportunity to reassure my community that it is possible to contend with a challenging diagnosis and to continue meaningful work, as have many before me. I hope that by writing candidly, I can help make a difference for those who may be experiencing similar challenges.
As the semester moved along, I tried to keep the same robust schedule I’ve always maintained with a few modifications for my treatment. For example, many people are shocked to find themselves scheduled in a meeting with me the day after chemo. It’s two to four days after these treatments that become challenging for me because the steroids in my system are wearing off. Through the generosity of the college’s trustees, I am now driven to work and to my daily professional appointments. It was difficult for me to accept such support given how much I value self-reliance, but not having to personally drive has made a huge difference in my ability to maintain my working schedule.
One aspect of my treatment that I find particularly difficult is the requirement that I avoid large groups because of my weakened immune system. For a college president who regularly meets with students, faculty, alumni, staff, community members, and donors, this was a tough change. However, there is really no way to get around this important requirement. I have had to make adjustments such as canceling my annual fall community meeting and missing the annual faculty and staff holiday party.
A cancer diagnosis of any kind constitutes an unspeakable event for many people. There is no escaping the facts: cancer affects one in two American men and one in three American women, according to the American Cancer Society. Changing societal attitudes about cancer so that we talk about it in honest and authentic terms and arm ourselves with knowledge can only help us in dealing with the No. 2 cause of death in the United States.
Fear of breast cancer plagues patients, survivors and women who do not have the disease. Even women who acknowledge knowing that heart disease is the number one cause of death in the United States fear that they will most likely die from breast cancer. Such fear too often leads to avoidance of screening or even seeing a physician for self-identified symptoms, creating great risk of more serious disease.
I have generally shared these fears, particularly as I visited the Avon Foundation Comprehensive Breast Evaluation Center at Massachusetts General Hospital (MGH) every year for several decades for my annual mammogram. Many who participate in this important test will say that the waiting room is a quiet and sober place. All of us know why: Most of us will leave with a clean bill of health, while others require further review. This year I was in the second group, and while the anticipation was terrifying, it prepared me for my important learning that putting my life before my fear was the best way for me to handle the fear.
During diagnosis, surgery, and now chemotherapy, I have seen that my single greatest source of fear is lack of any sense of understanding or control over what will happen. My response has been to be as engaged a patient as I can be while soliciting as much information about my treatment from my care team as I can handle. Facing the fear head-on is empowering, oddly enough, and finding role models who have done so in any circumstance has been especially helpful. When I write about my experiences with breast cancer, I try to be as explicit as possible about how I am dealing with the fears associated both with the disease and the treatment.
In addition to the fear factor, I have observed what I consider is the diabolical confusion in the marketplace about the efficacy of mammography screening. The American Cancer Society advises annual mammograms for all women age 40 and over, while the United States Preventative Task Force (USPTF) a government agency, recommends biennial mammography after age 50 until age 74. In addition to confusion, this government advice opens the door to changes in reimbursement for testing done outside guidelines, particularly worrisome as we consider the ongoing national concerns about health care affordability.
Daniel Kopans, a physician at MGH, has been a particularly committed advocate for mammography in the face of this confusion, and cites both the poor quality of the Canadian studies, which are the basis for the USPTF guidelines, and the lack of media attention to the new Canadian studies, which demonstrate results supporting the value of mammography. As a woman who clearly benefited from annual mammography, I think anything less is a disservice to all of us.
My primary care physician has steadfastly advised me to have annual mammograms over the course of our 20-year relationship, and I have never missed one. All previous tests revealed nothing abnormal, but in the fall, the test revealed a stage 1, grade 3 tumor. Stage 1 is an early finding of a tumor less than 2 centimeters in size, while a grade 3 tumor is the most aggressive kind of tumor. Had I delayed this mammogram, the progress of the disease was inevitable. My story is the classic scenario in support of annual mammograms. However, women in the United States face great confusion due to significant differences in the recommendations of key advisers.
My battle with breast cancer is now fully engaged, and I am committed to all aspects of the fight – surgery, chemotherapy, radiation and long-term medication – and to doing everything in my power to defeat this disease. One of the unexpected gifts of this experience is that I see life with more clarity and in a more intense light than ever before and I feel a sense of urgency in everything that I do – for myself, for my family, for the college. We just need to get on with it – face our challenges squarely and make every minute count. There is no time to waste.
I trust that by sharing my experiences with those in the Simmons College community, I can help them face the challenges in their lives, too, whatever those are, and inspire them to engage their own challenges with tenacity.
The Lumina Foundation and Indiana University’s Center for Postsecondary Education will be taking over the important Carnegie Classification of Institutions of Higher Education, from the Carnegie Foundation for the Advancement of Teaching. Lumina announced that its Degree Qualifications Profile (DQP) will inform the 2015 edition of the classification. This development is yet another step away from the original intent of the classification -- to provide an objective and easy-to-understand categorization of American postsecondary institutions.
In recent years, the Carnegie Foundation made its categories more complex: in part to suit the foundation’s specific policy orientations at the time, and in part to reflect the increased complexity of higher education institutions. As a result, the classification became less useful as an easy yet reasonably accurate and objective way to understand the shape of the system, and the roles of more than 4,500 individual postsecondary institutions.
Among the great advantages of the original classification were its simplicity and its objectivity, and the fact that it did not rank institutions but rather put them into recognizable categories. Unlike the U.S. News and World Report and other rankings, the Carnegie Classification did not use reputational measures—asking academics and administrators to rank competing colleges and universities. It relied entirely on objective data.
It is not clear how the classification’s new sponsors will change its basic orientation, and its new director says that the 2015 version will not be fundamentally altered. Yet, given Lumina’s strong emphasis on access, equity, and degree completion, as well as designing a new national credential framework — highly laudable goals of course — it is likely that the classification in the longer term will be shaped to be aligned with Lumina’s policy agenda, as it was more subtly changed in its later Carnegie years.
The original Carnegie Classification contributed immensely to clarifying the role of postsecondary institutions and made it possible for policy-makers as well as individuals in the United States and abroad to basically understand the American higher education landscape as a whole and see where each institution fit in it. The classification was also quite useful internationally — it provided a roadmap to America’s many kinds of academic institutions. An overseas institution interested in working with a research university, a community college, or a drama school could easily locate a suitable partner. We are likely to lose this valuable resource.
A Historical Perspective
The classification dates back to 1973, when the legendary Clark Kerr, having devised the California Master Plan a decade earlier and leading the Carnegie Commission on Higher Education, wanted to get a sense of America’s diverse and at the time rapidly expanding higher education landscape. The original classification broadly resembled Kerr’s vision of a differentiated higher education system, with different kinds of institutions serving varied goals, needs, and constituencies. It included only five categories of institutions — doctoral granting, comprehensive universities and colleges, liberal arts colleges, two-year colleges and institutes, and professional schools and other specialized institutions, along with several subcategories.
Because the classification was the first effort to categorize the system, it quickly became influential — policy-makers valued an objective data based categorization of institutions and academic leaders found it useful to understand where their own institutions fit. The classification had the advantage of simplicity, and its sponsor was trusted as neutral. Although the classification was not a ranking — it listed institutions by category in alphabetical order, many came to see it in competitive terms. Some universities wanted to join the ranks of the subcategory of “research university–I,” those institutions that had the largest research budgets and offered the most doctoral degrees — and were overjoyed when their institution was listed in that category. Similarly, the most selective liberal arts colleges were in “liberal arts colleges–I,” and many wanted to join that group. Over time, the classification became a kind of informal measure, if not of rank, at least of academic status.
Fiddling and Changing
The classification’s categories and methodology remained quite stable over several decades of major transformation in American higher education. In 2005, with new leadership at the Carnegie Foundation, major changes were introduced. Foundation leaders argued that the realities of American higher education required rethinking the methodology. It is also likely that the foundation’s focus changed and it wanted to shape the classification to serve its new orientation and support its policy foci. The foundation revised the basic classification, added new categories such as instructional programs, student enrollment profiles, and others. The classification became significantly more complex, and over time became less influential. People found that the new categories confused the basic purpose of the classification and introduced variable that did not seem entirely relevant. The basic simplicity was compromised. Indeed, people still refer to “Carnegie Research 1” (top research universities) even though they have not existed in the Carnegie lexicon for two decades.
There may well be more fiddling — the U.S. federal government’s desire to rank postsecondary institutions by cost and degree completion rates may add a further dimension to the enterprise. A further dilemma is the role of the for-profit higher education sector — these entities are fundamentally different in their orientations and management from traditional non-profit institutions — so also are the new online degree providers. Should these new additions to the higher education landscape be included in the classification? These elements will contribute to “classification creep” — a bad idea.
What Is Really Needed
It is surprising that, in the four decades since Clark Kerr conceptualized the Carnegie Classification, no one has stepped forward to provide a clear and reasonably objective and comprehensive guide to the more than 4,500 postsecondary institutions in the United States. Resurrecting the basic purpose and organization of Kerr’s original Carnegie Classification is not rocket science, nor would it be extraordinarily expensive.
It is of course true that the postsecondary education has become more complex. How would one deal with the for-profit sector? Probably by adding a special category for them. Many community colleges now offer four-year bachelors degrees, but their basic purpose and organization has not essentially changed. There are a larger number of specialized institutions, and many colleges and universities have expanded and diversified their degree and other offerings. Technology has to some extent become part of teaching programs of some postsecondary institutions — and the MOOC revolution continues to unfold. Research productivity has grown dramatically, and research is reported in more ways. Intellectual property of all kinds has become more central to the academic enterprise — at least in the research university sector.
Yet, the basic elements of the original classification — those that help to determine the main purposes and functions of postsecondary institutions — remain largely unchanged, if somewhat more complicated to describe. The key metrics are clear enough:
Types of degrees offered
Number of faculty, full-time and part-time
Income from research and intellectual property
Internationalization as measured by student mobility.
A few more might be added — but again, simplicity is the watchword.
The types of institutions — six main and eight major subcategories — seem about right. These might be expanded somewhat to accommodate the growth in complexity and diversity of the system. Later iterations confusingly expanded the categories, in part to reflect the policy and philosophical orientations of the foundation. The basic purpose of the classification will be best served by keeping the institutional typology as simple and straightforward as possible.
While it is clear that these metrics may not provide a sophisticated or complete measure of each institution — and they require additional definitions — they will provide basic information that will make reasonably categorization possible. They lack the philosophical and policy orientations that have crept into the Carnegie Classification in recent years, and return the enterprise to its original purpose — describing the richness, diversity, and complexity of the American higher education landscape.
Philip G. Altbach is research professor and director of the Center for International Higher Education at Boston College.