The Art of Small Goals - What Could Chinese Middle Schools Teach Us

In 1977, 5.7 million Chinese high school grads enrolled in an entrance exam. Those who scored top 278,000 were admitted into colleges. In 1985, 1.8 million enrolled in college entrance exam. 560,000 passed. And to get into Top 36 national universities, the competition is brutal.

But there are schools consistently sending most their kids to top colleges. They are called "key" middle schools, elite members of China's secondary education system. What is the secret sauce to ace their game?

A typical Chinese middle school has a junior division equivalent to K6-K9, and a senior division, equivalent to high school. Kids spend 3 years in the junior division then another 3 in the senior one.

Each middle school belongs to one of the two categories: “key” or non-key. Key middle schools earn their prestigious badges by consistently graduating 90% of their kids to colleges, compared to 20% or less for their non-key counterparts. 

For the top 36 Chinese Universities, their students almost exclusively come from these "key" middle schools, who dominate China’s college entrance exams for decades.

Everyone in China knows if kids survive a “key” middle school, a good college is out of question. 

A retired teacher who led such programs deciphered the strategy for me: It is all about managing small goals consistently for 6 years. 

Here is how it works: 

• The Chinese education system is notorious for all kinds of endless tests to constantly rank students within the same municipality, region, province or even nationally. Year 1, through many exercises, the key middle schools will march every kid to rank above the top 50 percentile –"let’s beat the other half". Sounds quite modest, right?

• Year 2, they march kids to beat the other half again. This time, not against everyone but the top 50%. The goal is to get everyone from top 50% to top 25%, so they will belong to the “better half of the better half”.

• Year 3. Same game. They march every kid from 25% top 12.5% - still, "beat the other half".

• By Year 6 when kids are ready for college entrance exams, almost every one ranks among the top 1.25%.

Of course, in a system where 30% high school grads could get into colleges, these elites write their own tickets.

Why small goals? 

People are mostly motivated by attainable goals. By breaking big goals into a consecutive string of achievable smaller goals, people are more likely to achieve them. This is how every "key" middle school in China turns kids into self-propelled Energizer Bunnies. These kids are not necessarily the most gifted but definitely the most motivated and disciplined.

What could we learn from this?

Healing stroke is a little like acing the intense competition of a Chinese college entrance exam. It takes a long time to ramp up, unbelievable amount of hard work, lots of commitment and persistence to achieve the best outcome. To beat the odds, one needs various therapies, commitment to exercise, and relentless focus. And most important, the art of managing small goals to keep all the above going. The good news is, few of us need to rank above the top 1.25% to see results.

“You Should Stay Positive”- overused cliche for stroke survivors

When psychologists go to counsel the stroke survivors fighting to get their functions back, they often say: you need to stay positive…you need to be thankful…you need to…

This is really an overused cliché. And we are glad the British Royal Academy is advising doctors and psychologists be careful about its implication. To help well intentioned psychologists understand why, let’s go through the following conversation one of our stroke survivor friends Jim has shared with us. 

Our friend Jim suffered vocal cord paralysis and was fighting hard to get his voice back - he was singing in the choir before the stroke suddenly knocked him down. Because of the paralysis, he could not swallow, his phlegm was overflowing, and the most painful, his voice was so hoarse and weak that he had a hard time communicating.

Thank God, through acupuncture and persistent efforts, Jim's voice made a marvelous come back in Year 3. The conversation below took place in the acute rehab stage. One month after stroke, Jim was frustrated that there was not so much progress no matter how hard he tried. He was really afraid the loss would stay permanent. So the hospital sent an Ivy League trained psychologist, Dr F, to talk to him.

Dr F: you know Jim, you can still make the best out of what you are left with. Be positive. Your voice is very hoarse. But you can write down what you want to say. You can be an excellent writer. You can also wear a microphone to magnify your voice when talking. Many survivors like you make do with what's left. They still have a very happy and productive life. There are just so many things you can be grateful to…

Jim: Dr F, let me ask you a question. Are you a mom?

Dr F: Yes. A very busy mom of two teenagers.

Jim: So you have 2 kids.

Dr F: Yes, 2. A son and a daughter.

Jim: Let’s say God forbid, your son went missing one night, and you called 911. The policewoman listened to your story and said, you know you still have one daughter left. There are many moms who lost a son. But they still managed to live a happy and productive life. There are so many things to be grateful to…what would you do?

Dr F: I would yell at that heartless woman. I would pounce at her and strangle her if that was face to face.

Jim: But you are just like that policewoman to us every day.

How to pick the acupuncture doctor for stroke recovery

How can one tell a good doctor?

The difference between a top rate acupuncture doctor and a mediocre one is like day and night. Picking the right acupuncture doctor is crucial to stroke recovery.

You would follow the same process to choose any trusted professional. The focus is primarily on two credentials:

1.      a solid theoretical foundation. This is obtained through 4 years of rigorous college level training, ideally in Mainland China or Taiwan with a degree in herbal medicine or acupuncture.

2.      long time practice under an accomplished master. Knowing where the meridian points are does not make a qualified acupuncture doctor. One has to know how deep the needles should go, what meridian points work together, how to handle different symptoms etc. Such knowledge is only passed on through apprenticeship. Apprenticeship to acupuncture is like residency to Western Medicine.

Most practicing acupuncturists did not come with the college training mentioned above. Some went through a trade school like training program just to get a license. If you look for someone to give you a relief for back pain for 2 weeks, this might be okay. However, if you look for someone to help with stroke recovery, then the screening process has to be far more selective.

Many research programs trying to find out the effectiveness of acupuncture do not have a rigorous screening process over the acupuncturists. This is like doing an analysis on restaurant industry assuming Morton Steak and McDonald's are equals. The sample data became very biased to start with. Of course, no one should be surprised to learn that they always conclude acupuncture ineffective in healing stroke.

Logistics is as important

Logistics is as important. Do not expect a magic session where the survivor is totally relieved of all the symptoms. It takes persistence. Usually, a few months are required at least before dramatic improvements could be seen. But baby steps do add up. 

Because of this, finding a clinic in the driving distance is key. There is no question that LA probably has the highest concentration of North America's best acupuncture doctors. the plan includes a stay for at least 2 months. And plan on visiting the right acupuncturist 4 times a week. Each session will be 1.5 hours. 

Get it early

The earlier one receives the acupuncture treatment, the better off it will be. In the acupuncture world, people say that one session in the first 6 months, is equal to many sessions after 18 months. Starting early lays a solid foundation.

What are the things that acupuncture is effective for

Acupuncture can be very helpful in treating cardiovascular disorders, hormonal imbalance and neurological injuries like stroke. It is not for everything. It may not be the right treatment for tumor and infection.

Acupuncture can help reduce the muscle spasm and pain. Combined with physical therapy accelerating the recovery, it can greatly accelerate the recovery.

The following is a video record on how this could work. (Dr Zhu in this video is a top acupuncturist who practices in San Jose)

Another area acupuncture could help a lot is vocal cord recovery. Vocal cord paralysis is one of the most common and painful symptoms stroke survivors have to deal with. The paralysis keeps the survivor from swallowing normally, and makes it hard for the survivor to talk because the voice is so low. Moreover, it causes constant overflow of phlegm, making it hard for the survivor to sleep well during the night. Stopping the phlegm and restoring the basic vocal cord function is where acupuncture could really shine beyond any other treatment methods.

What Might Mr. Jesty Tell Stroke Survivors

Benjamin Jesty

Benjamin Jesty, the British farmer in Dorset tried “cowpox” to vaccinate his family in 1774. According to historical documents, Benjamin administered this “alternative care” to his wife Elizabeth and 2 sons by rubbing the cowpox pus onto their arms. 22 years later, Dr Edward Jenner repeated a similar approach on James Phipps, the son of Jenner's poor gardener on May 14th, 1796. Jenner later published his experiment and findings which earned him the reputation of the "Father of Immunology".

Unlike Jenner, Jesty did not receive any credit for his brave experiment. Instead, he was reviled by his neighbors and countrymen as a reckless Chicanery. People concluded that his dangerous adventure would turn his unfortunate family into cows, or at least lead them to grow horns. 

In contrast, Jenner was appointed Physician Extraordinary by King George IV in 1821. Jennerian Society was formed by his enthusiastic followers in the medical community. The report Jenner submitted to the Royal Society led the British Government to start providing free vaccination to the general public in 1840.

Jenner Inoculating Phipps

However, in the eyes of the die-hard scientists of his time, Edward Jenner’s mere contribution was to scientifically prove that vaccination could work. The mechanism underneath was left to debate and further investigation. Hence, vaccination was still a novel "alternative care" whose value should be taken with a grain of salt. By today's standard, Jenner's publications on vaccination was still full of misleading hypothesis and errors.

It was not until 1870s, the remarkable French biologist Louis Pasteur discover the mechanism of immunization. After that, this particular type of alternative care was improved over the time into a repeatable mainstream treatment process.

Edward Jenner

Jesty never regretted being “passed over” for credit despite his contribution:

1.  The experiment saved his family who survived the terrible Smallpox Outbreak that nearly wiped out all their neighbors. His wife lived another 50 some years after the inoculation.
2.  Jesty humbly admitted that he was not the inventor of this method. The Chinese farmers were inoculating their families since 1000 BC. Africans and Turks had been using this approach for centuries to prevent smallpox.

As Jesty’s story demonstrated, there are two ways to discover new “cures” :

1.       Turn a lab finding into a treatment, like penicillin and;
2.       Try an effective treatment first. Grasp the scientific mechanism underneath and turn it into a standardized approach, like vaccination.

Today, we still depend far more on the first approach. Although we no longer predict that alternative cares would result in people growing horns, we are still skeptical about anything not coming from a lab. 

Louis Pasteur

Let’s fast forward our imagination 200 years to a time when stroke is under total control. Our grand-grand children might read the following in their history books:

• Between 1970s and 1990s, neuroplasticity was discovered and proven in the lab;
•  Some time in the 21^st century, some stroke patients tried a novel method to engage neuroplasticity which dramatically improved their recovery;
• 2 decades later, lab scientists fully grasped the underlying mechanism that made the mechanism work;
•  In the following decade, this new finding turned the approach into a standardized treatment procedure for stroke;
• In 2016, the break through Stanford Stem Cell Trial indicated that the day might come when healing stroke is like healing a fractured bone.

If so, do survivors want to wait until the Pasteur for stroke is born or act like the Jesty family to adopt an experiment in a brave but informed manner? 

Maybe for survivors, the list comparable to Benjamin Jesty’s primitive “alternative care” should include Acupuncture, Yoga, Taich, meditation and Guided imagery etc.