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American Educational Research Journal Publishes original  articles that advance the empirical, theoretical, and methodological understanding of education and learning.  View journal website . | @ aerj_journal

Educational Evaluation and Policy Analysis Publishes scholarly manuscripts of theoretical, methodological, or policy interest to those engaged in educational policy.  View journal website . |  @ EEPAjournal

Educational Researcher Publishes articles of general significance to the education research community. A ims to make major programmatic research and important findings widely accessible.  View journal website . | @ ERjournal_AERA

Journal of Educational and Behavioral Statistics An outlet for papers that are useful to those applying statistical approaches to issues in educational or behavioral research.  View journal website .

Review of Educational Research Publishes critical, integrative reviews of research literature bearing on education.  View journal website . | @RERjournal_AERA

Review of Research in Education Each annual volume p rovides a forum for analytic research reviews on selected education topics of significance to the field.  View journal website .

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Harvard educational review.

Edited by Maya Alkateb-Chami, Jane Choi, Jeannette Garcia Coppersmith, Ron Grady, Phoebe A. Grant-Robinson, Pennie M. Gregory, Jennifer Ha, Woohee Kim, Catherine E. Pitcher, Elizabeth Salinas, Caroline Tucker, Kemeyawi Q. Wahpepah

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Journal Information

• ISSN: 0017-8055
• eISSN: 1943-5045
• Keywords: scholarly journal, education research
• First Issue: 1930
• Frequency: Quarterly

Description

The Harvard Educational Review (HER) is a scholarly journal of opinion and research in education. The Editorial Board aims to publish pieces from interdisciplinary and wide-ranging fields that advance our understanding of educational theory, equity, and practice. HER encourages submissions from established and emerging scholars, as well as from practitioners working in the field of education. Since its founding in 1930, HER has been central to elevating pieces and debates that tackle various dimensions of educational justice, with circulation to researchers, policymakers, teachers, and administrators.

Our Editorial Board is composed entirely of doctoral students from the Harvard Graduate School of Education who review all manuscripts considered for publication. For more information on the current Editorial Board, please see here.

A subscription to the Review includes access to the full-text electronic archives at our Subscribers-Only-Website .

Editorial Board

2023-2024 Harvard Educational Review Editorial Board Members

Maya Alkateb-Chami Development and Partnerships Editor, 2023-2024 Editor, 2022-2024 [email protected]

Maya Alkateb-Chami is a PhD student at the Harvard Graduate School of Education. Her research focuses on the role of schooling in fostering just futures—specifically in relation to language of instruction policies in multilingual contexts and with a focus on epistemic injustice. Prior to starting doctoral studies, she was the Managing Director of Columbia University’s Human Rights Institute, where she supported and co-led a team of lawyers working to advance human rights through research, education, and advocacy. Prior to that, she was the Executive Director of Jusoor, a nonprofit organization that helps conflict-affected Syrian youth and children pursue their education in four countries. Alkateb-Chami is a Fulbright Scholar and UNESCO cultural heritage expert. She holds an MEd in Language and Literacy from Harvard University; an MSc in Education from Indiana University, Bloomington; and a BA in Political Science from Damascus University, and her research on arts-based youth empowerment won the annual Master’s Thesis Award of the U.S. Society for Education Through Art.

Jane Choi Editor, 2023-2025

Jane Choi is a second-year PhD student in Sociology with broad interests in culture, education, and inequality. Her research examines intra-racial and interracial boundaries in US educational contexts. She has researched legacy and first-generation students at Ivy League colleges, families served by Head Start and Early Head Start programs, and parents of pre-K and kindergarten-age children in the New York City School District. Previously, Jane worked as a Research Assistant in the Family Well-Being and Children’s Development policy area at MDRC and received a BA in Sociology from Columbia University.

Jeannette Garcia Coppersmith Content Editor, 2023-2024 Editor, 2022-2024 [email protected]

Jeannette Garcia Coppersmith is a fourth-year Education PhD student in the Human Development, Learning and Teaching concentration at the Harvard Graduate School of Education. A former public middle and high school mathematics teacher and department chair, she is interested in understanding the mechanisms that contribute to disparities in secondary mathematics education, particularly how teacher beliefs and biases intersect with the social-psychological processes and pedagogical choices involved in math teaching. Jeannette holds an EdM in Learning and Teaching from the Harvard Graduate School of Education where she studied as an Urban Scholar and a BA in Environmental Sciences from the University of California, Berkeley.

Ron Grady Editor, 2023-2025

Ron Grady is a second-year doctoral student in the Human Development, Learning, and Teaching concentration at the Harvard Graduate School of Education. His central curiosities involve the social worlds and peer cultures of young children, wondering how lived experience is both constructed within and revealed throughout play, the creation of art and narrative, and through interaction with/production of visual artifacts such as photography and film. Ron also works extensively with educators interested in developing and deepening practices rooted in reflection on, inquiry into, and translation of the social, emotional, and aesthetic aspects of their classroom ecosystems. Prior to his doctoral studies, Ron worked as a preschool teacher in New Orleans. He holds a MS in Early Childhood Education from the Erikson Institute and a BA in Psychology with Honors in Education from Stanford University.

Phoebe A. Grant-Robinson Editor, 2023-2024

Phoebe A. Grant-Robinson is a first year student in the Doctor of Education Leadership(EdLD) program at the Harvard Graduate School of Education. Her ultimate quest is to position all students as drivers of their destiny. Phoebe is passionate about early learning and literacy. She is committed to ensuring that districts and school leaders, have the necessary tools to create equitable learning organizations that facilitate the academic and social well-being of all students. Phoebe is particularly interested in the intersection of homeless students and literacy. Prior to her doctoral studies, Phoebe was a Special Education Instructional Specialist. Supporting a portfolio of more than thirty schools, she facilitated the rollout of New York City’s Special Education Reform. Phoebe also served as an elementary school principal. She holds a BS in Inclusive Education from Syracuse University, and an MS in Curriculum and Instruction from Pace University.

Pennie M. Gregory Editor, 2023-2024

Pennie M. Gregory is a second-year student in the Doctor of Education Leadership (EdLD) program at the Harvard Graduate School of Education. Pennie was born in Incheon, South Korea and raised in Gary, Indiana. She has decades of experience leading efforts to improve outcomes for students with disabilities first as a special education teacher and then as a school district special education administrator. Prior to her doctoral studies, Pennie helped to create Indiana’s first Aspiring Special Education Leadership Institute (ASELI) and served as its Director. She was also the Capacity Events Director for MelanatED Leaders, an organization created to support educational leaders of color in Indianapolis. Pennie has a unique perspective, having worked with members of the school community, with advocacy organizations, and supporting state special education leaders. Pennie holds an EdM in Education Leadership from Marian University.

Jennifer Ha Editor, 2023-2025

Jen Ha is a second-year PhD student in the Culture, Institutions, and Society concentration at the Harvard Graduate School of Education. Her research explores how high school students learn to write personal narratives for school applications, scholarships, and professional opportunities amidst changing landscapes in college access and admissions. Prior to doctoral studies, Jen served as the Coordinator of Public Humanities at Bard Graduate Center and worked in several roles organizing academic enrichment opportunities and supporting postsecondary planning for students in New Haven and New York City. Jen holds a BA in Humanities from Yale University, where she was an Education Studies Scholar.

Woohee Kim Editor, 2023-2025

Woohee Kim is a PhD student studying youth activists’ civic and pedagogical practices. She is a scholar-activist dedicated to creating spaces for pedagogies of resistance and transformative possibilities. Shaped by her activism and research across South Korea, the US, and the UK, Woohee seeks to interrogate how educational spaces are shaped as cultural and political sites and reshaped by activists as sites of struggle. She hopes to continue exploring the intersections of education, knowledge, power, and resistance.

Catherine E. Pitcher Editor, 2023-2025

Catherine is a second-year doctoral student at Harvard Graduate School of Education in the Culture, Institutions, and Society program. She has over 10 years of experience in education in the US in roles that range from special education teacher to instructional coach to department head to educational game designer. She started working in Palestine in 2017, first teaching, and then designing and implementing educational programming. Currently, she is working on research to understand how Palestinian youth think about and build their futures and continues to lead programming in the West Bank, Gaza, and East Jerusalem. She holds an EdM from Harvard in International Education Policy.

Elizabeth Salinas Editor, 2023-2025

Elizabeth Salinas is a doctoral student in the Education Policy and Program Evaluation concentration at HGSE. She is interested in the intersection of higher education and the social safety net and hopes to examine policies that address basic needs insecurity among college students. Before her doctoral studies, Liz was a research director at a public policy consulting firm. There, she supported government, education, and philanthropy leaders by conducting and translating research into clear and actionable information. Previously, Liz served as a high school physics teacher in her hometown in Texas and as a STEM outreach program director at her alma mater. She currently sits on the Board of Directors at Leadership Enterprise for a Diverse America, a nonprofit organization working to diversify the leadership pipeline in the United States. Liz holds a bachelor’s degree in civil engineering from the Massachusetts Institute of Technology and a master’s degree in higher education from the Harvard Graduate School of Education.

Caroline Tucker Co-Chair, 2023-2024 Editor, 2022-2024 [email protected]

Caroline Tucker is a fourth-year doctoral student in the Culture, Institutions, and Society concentration at the Harvard Graduate School of Education. Her research focuses on the history and organizational dynamics of women’s colleges as women gained entry into the professions and coeducation took root in the United States. She is also a research assistant for the Harvard and the Legacy of Slavery Initiative’s Subcommittee on Curriculum and the editorial assistant for Into Practice, the pedagogy newsletter distributed by Harvard University’s Office of the Vice Provost for Advances in Learning. Prior to her doctoral studies, Caroline served as an American politics and English teaching fellow in London and worked in college advising. Caroline holds a BA in History from Princeton University, an MA in the Social Sciences from the University of Chicago, and an EdM in Higher Education from the Harvard Graduate School of Education.

Kemeyawi Q. Wahpepah Co-Chair, 2023-2024 Editor, 2022-2024 [email protected]

Kemeyawi Q. Wahpepah (Kickapoo, Sac & Fox) is a fourth-year doctoral student in the Culture, Institutions, and Society concentration at the Harvard Graduate School of Education. Their research explores how settler colonialism is addressed in K-12 history and social studies classrooms in the United States. Prior to their doctoral studies, Kemeyawi taught middle and high school English and history for eleven years in Boston and New York City. They hold an MS in Middle Childhood Education from Hunter College and an AB in Social Studies from Harvard University.

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Article Submission FAQ

Submissions, question: “what manuscripts are a good fit for her ”.

Answer: As a generalist scholarly journal, HER publishes on a wide range of topics within the field of education and related disciplines. We receive many articles that deserve publication, but due to the restrictions of print publication, we are only able to publish very few in the journal. The originality and import of the findings, as well as the accessibility of a piece to HER’s interdisciplinary, international audience which includes education practitioners, are key criteria in determining if an article will be selected for publication.

We strongly recommend that prospective authors review the current and past issues of HER to see the types of articles we have published recently. If you are unsure whether your manuscript is a good fit, please reach out to the Content Editor at [email protected] .

Question: “What makes HER a developmental journal?”

Answer: Supporting the development of high-quality education research is a key tenet of HER’s mission. HER promotes this development through offering comprehensive feedback to authors. All manuscripts that pass the first stage of our review process (see below) receive detailed feedback. For accepted manuscripts, HER also has a unique feedback process called casting whereby two editors carefully read a manuscript and offer overarching suggestions to strengthen and clarify the argument.

Question: “What is a Voices piece and how does it differ from an essay?”

Answer: Voices pieces are first-person reflections about an education-related topic rather than empirical or theoretical essays. Our strongest pieces have often come from educators and policy makers who draw on their personal experiences in the education field. Although they may not present data or generate theory, Voices pieces should still advance a cogent argument, drawing on appropriate literature to support any claims asserted. For examples of Voices pieces, please see Alvarez et al. (2021) and Snow (2021).

Question: “Does HER accept Book Note or book review submissions?”

Answer: No, all Book Notes are written internally by members of the Editorial Board.

Question: “If I want to submit a book for review consideration, who do I contact?”

Answer: Please send details about your book to the Content Editor at [email protected].

Manuscript Formatting

Question: “the submission guidelines state that manuscripts should be a maximum of 9,000 words – including abstract, appendices, and references. is this applicable only for research articles, or should the word count limit be followed for other manuscripts, such as essays”.

Answer: The 9,000-word limit is the same for all categories of manuscripts.

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Answer: Any references that identify the author/s in the text must be masked or made anonymous (e.g., instead of citing “Field & Bloom, 2007,” cite “Author/s, 2007”). For the reference list, place the citations alphabetically as “Author/s. (2007)” You can also indicate that details are omitted for blind review. Articles can also be blinded effectively by use of the third person in the manuscript. For example, rather than “in an earlier article, we showed that” substitute something like “as has been shown in Field & Bloom, 2007.” In this case, there is no need to mask the reference in the list. Please do not submit a title page as part of your manuscript. We will capture the contact information and any author statement about the fit and scope of the work in the submission form. Finally, please save the uploaded manuscript as the title of the manuscript and do not include the author/s name/s.

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Answer: If you think your manuscript is a strong fit for HER, we welcome a request for invitation. Invited manuscripts receive one round of feedback from Editors before the piece enters the formal review process. To submit information about your manuscript, please complete the Invitation Request Form . Please provide as many details as possible. The decision to invite a manuscript largely depends on the capacity of current Board members and on how closely the proposed manuscript reflects HER publication scope and criteria. Once you submit the form, We hope to update you in about 2–3 weeks, and will let you know whether there are Editors who are available to invite the manuscript.

Review Timeline

Question: “who reviews manuscripts”.

Answer: All manuscripts are reviewed by the Editorial Board composed of doctoral students at Harvard University.

Question: “What is the HER evaluation process as a student-run journal?”

Answer: HER does not utilize the traditional external peer review process and instead has an internal, two-stage review procedure.

Upon submission, every manuscript receives a preliminary assessment by the Content Editor to confirm that the formatting requirements have been carefully followed in preparation of the manuscript, and that the manuscript is in accord with the scope and aim of the journal. The manuscript then formally enters the review process.

In the first stage of review, all manuscripts are read by a minimum of two Editorial Board members. During the second stage of review, manuscripts are read by the full Editorial Board at a weekly meeting.

Question: “How long after submission can I expect a decision on my manuscript?”

Answer: It usually takes 6 to 10 weeks for a manuscript to complete the first stage of review and an additional 12 weeks for a manuscript to complete the second stage. Due to time constraints and the large volume of manuscripts received, HER only provides detailed comments on manuscripts that complete the second stage of review.

Question: “How soon are accepted pieces published?”

Answer: The date of publication depends entirely on how many manuscripts are already in the queue for an issue. Typically, however, it takes about 6 months post-acceptance for a piece to be published.

Submission Process

Question: “how do i submit a manuscript for publication in her”.

Answer: Manuscripts are submitted through HER’s Submittable platform, accessible here. All first-time submitters must create an account to access the platform. You can find details on our submission guidelines on our Submissions page.

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Education Improves Public Health and Promotes Health Equity

Robert a. hahn.

1 Centers for Disease Control and Prevention, Atlanta, GA, USA

Benedict I. Truman

This article describes a framework and empirical evidence to support the argument that educational programs and policies are crucial public health interventions. Concepts of education and health are developed and linked, and we review a wide range of empirical studies to clarify pathways of linkage and explore implications. Basic educational expertise and skills, including fundamental knowledge, reasoning ability, emotional self-regulation, and interactional abilities, are critical components of health. Moreover, education is a fundamental social determinant of health – an upstream cause of health. Programs that close gaps in educational outcomes between low-income or racial and ethnic minority populations and higher-income or majority populations are needed to promote health equity. Public health policy makers, health practitioners and educators, and departments of health and education can collaborate to implement educational programs and policies for which systematic evidence indicates clear public health benefits.

Education is a process and a product . From a societal perspective, the process of education (from the Latin, ducere, “to lead,” and e, “out from,” yield education, “a leading out”) intentionally engages the receptive capacities of children and others to imbue them with knowledge, skills of reasoning, values, socio-emotional awareness and control, and social interaction, so they can grow as engaged, productive, creative, and self-governing members of a society. 1 Of course, not all educational institutions achieve these goals for all children – far from it; educational institutions in the United States often fall short of goals, and too many students may be led into school failure, social dysfunction, and marginal living conditions with lifelong disadvantages.

Not all learning is acquired in a formal school setting. The process of education occurs at home, in school, and in the child’s community. Children in the United States spend a relatively small proportion of their waking hours in school – approximately 1,000 hours per year or about one fifth of their waking hours. 2 Thus there are many opportunities for informal education outside the school setting. 3 When researchers find evidence linking mental capacities, knowledge, feelings, and values with health outcomes, 4 not all consequences can be attributed to formal education.

As the product of the educational process, an education is the array of knowledge, skills, and capacities (ie, intellectual, socio-emotional, physical, productive, and interactive) acquired by a learner through formal and experiential learning. An education is an attribute of a person. And, although a person may be said to “have” a certain level of education at any particular moment, educational attainment is a dynamic, ever-evolving array of knowledge, skills, and capacities.

Although we conceive of education broadly, including both its formal and informal sources, the focus of our evidence review is the formal education that is measured in most research. Our recommendation also focuses on the formal education, from early childhood to college and beyond, that is, the subject of educational policy and, we argue, should also be the subject of public health policy.

In public health, researchers and practitioners have examined 3 principal relationships between education and health. First, health is a prerequisite for education : hungry children or children who cannot hear well, or who have chronic toothaches, eg, are hindered in their learning. 5 Second, education about health (ie, health education) occurs within schools and in many public health interventions; it is a central tool of public health. 6 Third, physical education in schools combines education about the importance of physical activity for health with promoting such activity. 7 Here we focus on 2 additional relationships between education and health. First, we propose that education as a personal attribute is a central conceptual component and essential element of health , similar to physical fitness. Second, we summarize the extensive literature demonstrating that formal education is a contributing cause of health .

We argue that education – the product and personal attribute acquired – is both a critical component of a person’s health and a contributing cause of other elements of the person’s concurrent and future health. Consistent with other definitions of health, a person who lacks basic elements of an education is not fully healthy. 8 , 9 For example, the 1978 Alma Ata International Conference on Primary Health Care defined “health” to include “a state of complete…mental and social well-being” – which we see as largely products of education. Attainment of a certain level of formal education by young adulthood affects lifelong health through multiple pathways. 8 , 10

We then argue that, because it is both an essential component and a major contributing cause of health, educational achievement broadly should be a legitimate arena for public health intervention. Thus, public health practitioners could legitimately promote educational programs to advance public health. Education should also be recognized as an essential requirement for the disruption of the cycle of poverty and inequities in health. The public health community should expand research to better understand the causal relationships between education and health, and thereby identify evidence-based educational policies that have great potential to improve public health.

A Broad Concept of Education

We propose a broad concept of education as a personal attribute, which includes not only subject-matter knowledge, reasoning, and problem-solving skills, but also awareness of one’s own emotions and those of others and control of one’s emotions (ie, “emotional intelligence”) 11 and associated abilities to interact effectively. “Education improves health because it increases effective agency, enhancing a sense of personal control that encourages and enables a healthy lifestyle. Education’s beneficial effects are pervasive, cumulative, and self-amplifying, growing across the life course.” 12

In 1983, the National Commission on Excellence in Education’s report, A Nation at Risk , launched a national conversation about the need for educational reform. 13 In 1990, the US Department of Labor initiated a program – the Secretary’s Commission on Achieving Necessary Skills – to determine critical capacities for a US workforce to be provided by the educational system. 14 The capacities proposed were based on “a three-part foundation” reflecting the broad notion of education that we propose: Basic Skills (reading, writing, arithmetic, mathematics, listening, speaking), Thinking Skills (creative thinking, decision making, problem solving, seeing things in the mind’s eye, knowing how to learn, reasoning), and Personal Qualities (responsibility, self-esteem, sociability, self-management, integrity/honesty). The project recommends as a central educational goal: “All American high school students must develop a new set of competencies and foundation skills if they are to enjoy a productive, full, and satisfying life.” 14 (p1) We would expand this list of outcomes to include a healthy life.

Education as an Element of Health

In our conception, basic education is an integral part of being healthy. A person is unhealthy if he or she lacks basic knowledge, the ability to reason, emotional capacities of self-awareness and emotional regulation, and skills of social interaction. These embodied personal attributes or mental capacities, the products of formal education as well as other learning experiences, are conceptually comparable to physical capacities of fitness and coordination – well-established components of health. “Education teaches a person to use his or her mind: Learning, thinking, reasoning, solving problems, and so on are mental exercises that may keep the central nervous system in shape the same way that physical exercise keeps the body in shape.” 8 (p738) A person is unhealthy who cannot conduct himself or herself effectively and achieve some level of “social well-being” – a critical element of the World Health Organization (WHO) conception of health, which recognized the contributions of social sectors beyond the health sector in promoting health. 9

The projects of several US and international health agencies reflect this concept of education as a component of health. For example, the US Centers for Disease Control and Prevention recognizes “cognitive health” in its Healthy Aging Program; although the focus of this program is prevention and control of Alzheimer’s disease, the “cognitive health” rubric suggests far broader considerations: “The public health community should embrace cognitive health as a priority, invest in its promotion, and enhance our ability to move scientific discoveries rapidly into public health practice.” 15 (p1) The National Institutes for Health similarly has a “healthy brain” program that recognizes cognitive as well as emotional capacities as elements of health. 16

Similar concepts are recognized internationally by the WHO, in accordance with its definition of health cited above. More recently, a WHO paper 17 included cognition and affect as 2 of 6 domains for the international comparison of health status .

Measures of Education as a Personal Attribute

Education is measured in a variety of ways. A common measure, years of schooling/educational attainment, is problematic insofar as time spent in school gives little indication of how the time is spent and what is learned. 2 School-level completion may be a better measure, but also varies in terms of the quality and quantity of what is learned. Standardized tests of subject-matter knowledge and reasoning skills may be still better for some purposes, but may offer challenges when compared across populations. 18

Some 19 , 20 have argued that teacher-assigned grades are an alternate, if not better, predictor of long-term outcomes than standardized tests because they reflect not only academic achievement, but also classroom social and learning skills that indicate abilities to learn and to interact successfully. The breadth of skills addressed by this measure better reflects the broad concept of education argued here. Subjectivity, personal preferences, and comparability are challenges with teacher-assigned grades as a measure of achievement.

Evidence of Causal Association

It may seem odd that, in the perspective developed here, education – the product and the personal attribute – is at once an element of health and a cause of health. The relationship is similar to that of physical fitness and health. Fitness is an element of health and an important cause of subsequent health – not only of physical fitness, but of other facets of health as well, including cardiac health and mental health. 21 – 23 In addition to providing extensive evidence that education is associated with health, we argue that the underlying causal process is conceptually similar to the causal relationships between physical activity or an infectious agent and health. We provide some evidence of causation, noting that the notion of causal proof in a traditional deterministic sense has been challenged. 24

Criteria to determine causality in public health developed by Sir Bradford-Hill in 1965 25 are still useful. They are:

• Strength of association linking hypothetical cause and outcome (as assessed, eg, by the magnitude of relative risks)
• Consistency of findings, eg, by different researchers in different settings
• Specificity – the connection of specific, narrow causes to specific outcomes
• Temporal sequence—the necessity of cause preceding consequence
• Dose–response relationship
• Plausibility in terms of current knowledge
• Coherence – similar to plausibility, the fit with other contemporary knowledge
• Experiment – offering the strongest support
• Analogy – the comparability of postulated causality with causality in similar phenomena

Most of the Bradford-Hill criteria clearly apply when linking education to health. An obvious exception is specificity, because education itself is a broad concept including many elements, and the causal consequences of education are also numerous and heterogeneous. Bradford-Hill did not regard specificity as essential, as in the case of cigarette smoke with its multiple health consequences. As Susser has argued, “Specificity enhances the plausibility of causal inference, but lack of specificity does not negate it.” 26 (p153)

The associations presented below satisfy several standard criteria for causation. At least 3 approaches are used: 1) observational cohort studies with concurrent controls, 2) natural quasi-experiments in education policy, and 3) educational experiments. In the sections that follow, we provide samples of evidence of the causal association between education and health, assessed first by various health-related outcomes: health risk and protective behaviors, wages and income (resources for health), self-assessed health, morbidity, mortality, and life expectancy. We then provide evidence from experimental studies. The literature on these topics is extensive 4 , 8 and here we describe only a few examples, from early childhood and beyond. Evidence of the association between measures of education – the personal attribute – and other health-related outcomes is positive, strong, and consistent.

Health Risk and Protective Behaviors Are Associated With Academic Achievement

Evidence of an association between high school student grades and risk behaviors in the United States is remarkably consistent; higher average grade achievement is associated with lower rates of risk behavior ( Figure 1 ). 27 One plausible explanation is that there is causation in the reverse direction of what is proposed here, ie, that risk behavior interferes with academic achievement; such reverse causation seems reasonable, eg, for watching television and using alcohol. Also plausible is that other factors, such as strong values, promote both academic achievement and self-protective behaviors, or that academic achievement is associated with knowledge, which leads to risk avoidance. Another explanation is that underlying psychological or environmental conditions are associated with risk behavior and academic problems. Causation in both directions is likely. The consistency of a dose response for multiple behaviors is consistent with an effect of educational success on the avoidance of risky behavior.

Health-risk behaviors and school grades, United States, 2009.

Source: www.cdc.gov/healthyyouth/health_and_academics/pdf/health_risk_behaviors.pdf .

There is also strong evidence of a dose response between years of education and many health-related risk and protective behaviors among US adults. Analysis of a representative survey of adults aged >25 years between 1990 and 2000 indicates that the prevalence of several risk behaviors is generally higher among those with fewer than nine years of formal education, begins to decline among those who have nine to 12 years of formal education, and continues to decline with additional years of education; this finding corresponds to the recognized importance of high school completion for subsequent health. 28 , 29

Wages and Income, Resources for Health, Are Associated With Educational Success

Wages and income are not health outcomes, but are closely linked with health outcomes because they provide access to health-related resources, such as healthy food, a safe environment, and healthcare. A recent analysis 30 of trends in US wages over more than 20 years finds higher wages consistently associated with higher educational attainment and a trend toward increasing differences in wages by educational status. In the causal chain, high educational attainment is antecedent to high wages or income. A recent study 31 linking individual kindergarten standardized achievement tests with wages at ages 25–27 years indicates a remarkable linear association accounting for 17% of the variability in the wage outcome – 20 years later ( Figure 2 ). Although high family income precedes and predicts educational success in children, controlling for such demographic characteristics of the kindergartner (including family income, household ownership, and marital status) diminishes, but by no means eliminates, the association found in this study.

Association between kindergarten test score percentiles and mean wage earnings, ages 25–27 years, Tennessee STAR program.

Source: Chetty, 2010.

Self-Assessed Health Is Associated With Educational Attainment

Self-assessed health is a well-established index of morbidity and predictor of mortality. 32 , 33 A recent study compares the association of educational attainment with self-assessed health in US and Canadian populations. 34 , 35 Controlling for basic demographics and income, those with less than a high school education in the United States are 2.4 times as likely as high school graduates and 4.1 times as likely as those with post-secondary education to rate their health as poor. Further adjusting these ratios for risk behaviors only moderately reduces the ratios, suggesting that education is related to self-reported health due to important factors in addition to risk behaviors.

It is plausible that health status affects the likelihood of educational achievement, but it is likely that the major force of causation is in the opposite direction. Not only is educational attainment closely associated with self-rated health, but the association increases with age when measured by the number of days per week reported as free of major symptoms. With increasing age, the gap in symptom-free days increases between those with a college degree, those with a high school degree or some college, and those with less than a high school degree, suggesting that the effects of education are pervasive throughout the lifespan, and that its consequences have cumulative effects on health over time. 36

Morbidity is Associated With Educational Attainment

In the United States, although higher self-reported rates of several conditions, such as prostate cancer and sinusitis, are reported among more adults with greater levels of education, for most conditions the reverse direction of association is evident. Rates of major circulatory diseases, diabetes, liver disease, and several psychological symptoms (sadness, hopelessness, and worthlessness) show higher rates among adults with lower educational attainment. 35

Mortality and Life Expectancy Are Associated With Educational Attainment

Evidence also exists of a strong association between educational attainment and mortality from many diseases. 37 The parallel relationship for three heterogeneous groups of illness or injury again suggests an underlying connection unrelated to the specific etiologic pathways of each cause of death ( Figure 3 ). 37 In addition, the modal age for completing formal education (the mid-20 s) substantially precedes the peak age for mortality in the United States (77 years of age) by many years, consistent with another Bradford-Hill principle, ie, the precedence of cause before effect.

Age-adjusted death rates among persons ages 25–64 years for several condition groupings, by sex and educational attainment. Selected US states, 1994–2005.

From the perspective of life expectancy, at age 25 in 2005, a man in the United States with less than a high school education could expect to live an additional 44.2 years to age 69.2 years; a man with a graduate degree could expect to live more than 15 years longer. At age 25 years, a woman in the United States with less than a high school education could expect to live to age 74.9 years; a woman with a graduate degree could expect to live more than 11 years longer. 38

Educational Experiments and Quasi-Experiments

True experiments in the field of education are uncommon. Nevertheless, several experiments have been conducted. Groups of children, often from low-income or minority families, have been exposed, sometimes with random assignment, to different forms of education and followed over time to determine long-term outcomes, including health-related outcomes, as shown in the following 3 examples of early childhood programs.

In the early 1960s, 3- and 4-year-olds with low IQs from low-income families were randomly assigned to either the High/Scope Perry Preschool Program – an educational program including home visits – or no intervention. Home visits were designed to strengthen parental engagement in the child’s education. Participants were periodically assessed until age 40. 39 Over several follow-up assessments, intervention participants had greater levels of educational attainment, income, and health insurance, lived in safer family environments, and had lower rates of tobacco and drug use and risky driving behavior than controls. At age 40 years, however, more intervention than control participants had chronic diseases, but fewer intervention participants had died.

In 1972, healthy infants at risk of academic difficulties because of their demographic circumstances (eg, poor, minority, single parents) were randomly assigned to the Carolina Abecedarian Project or a control intervention (offered social services, nutritional supplements, and healthcare services, but no educational program). 40 The Abecedarian preschool program focused on developing cognitive, social, language, and motor skills from birth through age 5 years. Before entering kindergarten, control and experimental children were again randomized into either routine schooling or a strengthened school program complemented by home visits for parental guidance to reinforce child learning. At follow-up, both the preschool and the early schooling programs were shown to be beneficial in terms of academic achievement; the preschool program had the larger effect. By age 21 years, participants in the early childhood education intervention (combining those with and without the strengthened primary school programming) had better health behaviors and better health than those who did not receive the early childhood education intervention. 41 By their mid-30 s, those exposed to the intervention, particularly males, had substantially more favorable cardiovascular risk profiles than those exposed to the control condition. 42

Finally, though not a true experiment, the Chicago Child-Parent Center program followed two groups of poor Chicago children aged 3 and 4 years: one exposed to an early childhood program and the other not exposed. Children residing in Chicago districts with federally funded kindergarten programs were eligible and selected on a “most-in-need basis”; comparison children lived in similarly poor neighborhoods with locally funded kindergarten programs. The Chicago Child-Parent Center provided educational enrichment from prekindergarten through the third grade, required parental involvement in the classroom a half-day per week, and provided nutrition and health services. At age 24 years, in comparison with control subjects, participants had lower rates of out-of-home placement (indicating child abuse), lower rates of arrests and conviction for violent behaviors, and lower rates of disability. 43

A recent review of the effects of early childhood educational programs indicates that programs with strong instructional components and those evaluated with strong study designs have large and enduring effects on the educational, social, and health outcomes of participants. 44

Several researchers have made use of natural quasi-experiments involving education policies that rapidly change years of schooling required, to evaluate the effects of the requirement on health-related and other outcomes. When state educational requirements change from 1 year to the next from 7 to 9 years, eg, cohorts of children of a certain age in that state will receive approximately 7 years of education, while their younger siblings will receive 9 years. The state where this policy is implemented may be compared by regression discontinuity analysis from before to after the change, but also with other states that have not made this change at the same time.

In one such study, Lleras-Muney 45 uses a sample of US census data to estimate the effects on mortality of changes in compulsory education requirements in 30 states, comparing birth cohorts before and after such changes between 1915 and 1939 with long-term follow-up data. Lleras-Muney concludes that each year of additional required schooling resulted in a reduction of mortality by 3.6% over 10 years, or gain of 1.7 years to life expectancy at 35 years of age. Although these data are old, it is likely that the general effects of increased educational requirements on mortality have not changed substantially. Other researchers have used regression discontinuity analysis to estimate the effects of education on rates of crime, arrest, and incarceration in the United States 46 and on teenage births in the United States and Norway. 47 Among researchers using this design, only Arendt 48 finds equivocal evidence regarding the effects of additional years of education on self-rated health, body mass index, and smoking in the United States, Canada, and Denmark. The heterogeneity of conditions affected by educational exposure again suggests a broad, nonspecific underlying “mechanism.”

The Fallacy of the Endowment Hypothesis

Gottfredson has proposed that intelligence – innate intellectual and associated ability – rather than educational attainment is the “fundamental cause” of socioeconomic inequalities in health, a proposal referred to as the “endowment hypothesis.” 49 Several basic features distinguish Gottfredson’s notion of intelligence from the concept of education as defined in this article: intelligence is regarded as “natural, not cultural,” “context-free,” and “highly heritable” – indicating a largely innate, biological foundation, little affected by environmental variability. From this vantage, education as conceived in this article may be regarded as largely determined by intelligence insofar as those with greater intelligence are both more likely to seek education and to succeed in acquiring it.

Gottfredson’s hypothesis is explicitly evaluated by others in a study of 2 US cohorts that assesses the contributions of education, income, and intelligence to 3 health outcomes: mortality, life-threatening illness, and self-rated health. 50 The researchers posit an alternative model, in which there are underlying “background influences on [socioeconomic status] and intelligence.” In this model, intelligence affects education and income, and both of these socioeconomic status characteristics in turn affect intelligence; a summary of research on this linkage 51 indicates that a year of education is associated with a gain of between 2 and 4 IQ points. In both study cohorts, intelligence during high school is measured by standardized and validated tests, the Henmon-Nelson test and the Wechsler Adult Intelligence Scale. The researchers find generally consistent evidence of pairwise dose–response associations between levels of education, income, and intelligence with each of 3 health outcomes.

The researchers then examine the questions: what is the effect of controlling the association of education and health outcomes for intelligence; of income and health outcomes controlling for intelligence; and of intelligence and health outcomes controlling for both education and income? This assessment allows answering 2 basic questions: how much does intelligence contribute to the effects of education and of income on health, ie, what are the effects of these determinants net the contribution of intelligence? And, to what extent are the effects of intelligence on health mediated by income and education? The researchers find that separately controlling the effects of education and income on health outcomes for intelligence alters the coefficients for education and income minimally and leaves all associations statistically significant at the 0.05 level or less, indicating that little of the effect of education on health is mediated by intelligence.

The effects of controlling the effects of intelligence on health for education and income are more complex. Only 1 of the 2 surveys finds a significant effect of intelligence on mortality ( P <.05); controlling for education and income eliminates the significance of this finding. Thus, the effect of intelligence on mortality is largely mediated by income and education. Both surveys find statistically significant effects of intelligence for both life-threatening illnesses and self-rated health; however, the effect magnitudes are diminished by a mean of 69.4% and statistical significance is again eliminated for all findings except for self-rated health in one of the surveys. These findings indicate that the effects of intelligence on health outcomes are largely mediated by education and income. 50 There is thus substantial evidence that education has a strong effect on health, independent of background intelligence. Innate intelligence may be a “fundamental cause” principally insofar as it leads to higher education and income.

Causal Pathways and Evidence Linking Education and Health

Building on the work of others, 10 , 52 we constructed a model indicating the three major pathways linking education and health outcomes in adulthood and including the several facets of education – knowledge, problem solving, emotional awareness and self-regulation, values, and interactional skills ( Figure 4 ). First is the psycho-social environment, including the individual’s sense of control, social standing, and social support, which reflects and bolsters capacity and agency. Second is work, through which the individual may achieve satisfaction and income, which allows access to many health-related resources. Finally, healthy behavior may protect an individual against health risks and facilitate negotiation of the healthcare system.

Pathways from educational attainment to health outcomes.

Ross and Wu 8 used 2 national probability samples of US adults to assess the effects of completed education on self-perceived health and reported physical functioning. They first assessed the association between education and each of three broad covariate groups – psycho-social environment; work; and health knowledge, literacy, and behaviors – that are themselves determinants of health outcomes ( Figure 4 ). 8 For each data source, they began with a model including as covariates only demographic characteristics of their samples. To the basic model, they first added employment and economic covariates, then social-psychological covariates, and finally risk behavior covariates, noting the changes in regression coefficients for educational exposures on health outcomes. This approach allowed assessment of the magnitude of each of these groups of covariates as pathways linking education to health-related outcomes. However, the relative contribution of each group of factors cannot be determined precisely, because these groups are unlikely to be causally independent, and covariate groups entered into the regression early are thus likely to show greater reductions in regression coefficients than those entered later.

In both samples, education was associated with all covariates in expected directions. The largest effect was for work-related variables, including income. Those with lower income not only had limited resources useful in maintaining health, but also may have experienced anxieties that exacerbate health problems. The effects of psycho-social resources were also statistically significant and of similar magnitude. Risk behavior and knowledge also contributed to the association between education and health by both measures. The 3 clusters of covariates together explain between 55% and 59% of the variance in self-reported health and between 46% and 71% of physical functioning in these surveys. This suggests that the smallest contribution to health outcomes is associated with health behaviors, which were entered last into the regression model. In both samples, education has a significant residual “direct” effect, independent of the three examined pathways. In summary, education’s association with improved health is attributable to greater work opportunities and rewards, a greater sense of control and social support, healthier behaviors, and a direct effect on health. Similar results are found by Cutler and Lleras-Muney, 28 who use different sources to assess associations between educational attainment, health behaviors, and mortality in the United States and Great Britain.

In a separate study, Ross and Mirowsky 53 provide evidence that the effect of higher levels of education on health is mediated principally by its contents, including values and skills imparted, and far less by means of status markers such as the diploma or the prestige of the degree-granting institution. Evidence for this conclusion derives from a regression analysis of national data including measures of years of education, receipt of diplomas, and school selectivity (based on test scores of entering freshmen). In another study, Reynolds and Ross 54 provide evidence that “the direct effect of education on well-being is greater than the direct effect of social origins, and the total effect of social origins is mediated mostly by education.” 54 (p226) Evidence derives from a regression analysis of two national data sources in which the researchers control for parental education, father’s occupation, and childhood poverty. They also find that a person’s level of education has a far greater effect on health if his or her parents were poorly educated than if they were well-educated. Unfortunately, in our society, parental and child educational levels are highly positively correlated, so that the children of parents with little education, who might benefit the most from higher levels of education, are least likely to receive that education. 55

Ross and Mirowsky 55 (pp597,598) conclude (emphasis added): “…certain policy implications follow. First, education policy is health policy. Second, health policy must address the educational opportunities of children raised by poorly-educated parents. Otherwise those children, in adulthood, will suffer the multiplicative health consequences of low parental education and low personal education…Structural amplification condemns some families to the concentration of low education with poor health across generations… Break that mediating link, and the moderating effect of higher education will suppress the health disadvantages of the socially disadvantaged origins. ”

High Societal Price in Health of Education Forgone

An estimate of the number of annual deaths attributable to lack of high school education among persons 25–64 years of age in the United States (237,410) exceeds the number of deaths attributed to cigarette smoking among persons 35–64 years of age (163,500) (Krueger et al., unpublished manuscript, 2013). 56 (The estimate of smoking-attributable mortality does not include adults younger than 35 years of age because mortality from smoking is negligible at this age.)

Several recent estimates have been made of economic costs to individuals, the government, and society of the failure of each American to achieve an optimal education. Although it may be argued that there is a moral duty to redress injustice and inequity regardless of cost, these estimates indicate the economic magnitude of this loss and the potential value of its redress.

Schoeni and colleagues 57 , 58 estimate the annual economic value of health forgone in the United States in 2006 by adults who lack a college education. For a population of 138 million aged 25 years or older with less than a college education, the economic value of the life and health forgone is US$1.02 trillion per year – 7.7% of US gross domestic product.

Levin and colleagues 59 provide an estimate of benefits to the government (in 2004 dollars) if those who did not finish high school had completed a high school education (or higher) with a diploma. Based on governmental benefits of income taxes associated with greater earnings of high school graduates and reduced costs of welfare and incarceration, Medicaid, and lifetime savings of approximately US$40,000 per capita in public health expenses, they estimated a total lifetime benefit of US$209,000 for each high school dropout if he or she had instead completed high school. They then examined the costs and benefits of 5 programs with demonstrated efficacy in improving rates of high school completion. Cost–benefit ratios range from 1.5 to 3.5, indicating substantial governmental benefit. 59

Education as a Domain of Public Health Action

Just as many areas of daily life are recognized domains of legitimate public health action – agriculture (eg, nutrition and food safety), transportation (eg, vehicle injuries, air pollution, and walking), immigration (eg, immigrant health and infection control), justice (eg, violent crime and prison health), urban design (eg, safety, walkable communities, and food deserts), and labor (eg, occupational safety and health) – so should education (beyond health education in schools) be recognized as a legitimate domain of public health action. Education is a critical component of health and, we argue, education is a major, long-term, multifaceted cause of health. In particular, education is a powerful means of breaking the cycle of poverty (which greatly affects ethnic and racial minority populations) and promoting health equity.(As this article was in press, the authors encountered an excellent paper by Cohen and Syme 60 which draws similar conclusions.)

Several federal agencies have supported “health in all policies,” 61 particularly through the National Prevention, Health Promotion and Public Health Council. 62 The US Department of Health and Human Services includes in its mission 63 to “engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge” and in its overarching goals to “Create social and physical environments that promote good health for all.”

States and the District of Columbia have also adopted a “health in all policies” perspective. California’s “CAL Health in all Policies” 64 – 66 recognizes the potential for education as a means of moving toward health equity. “Promote efforts that demonstrate positive effects in closing the achievement gap. Collaborate on advancing strategies, addressing the major factors that inhibit the learning of all students.” Counties (eg, Los Angeles, Baltimore) also have adopted a “health in all policies” perspective. 64 , 67 , 68

The effort to pursue multi-sectoral strategies for health improvement is international, practiced in the European Union, Australia, and elsewhere. The European Union has adopted a social determinants-based approach: “Health in All Policies addresses the effects on health across all policies such as agriculture, education, the environment, fiscal policies, housing, and transport. It seeks to improve health and at the same time contribute to the well-being and the wealth of the nations through structures, mechanisms, and actions planned and managed mainly by sectors other than health.” 69 (pXVIII)

In “A Framework for Public Health Action: The Health Impact Pyramid,” 71 Frieden writes, “Interventions that address social determinants of health have the greatest potential public health benefit” and contrasts social determinants – the base of the “health impact pyramid” – with higher strata in the pyramid. 70 (p594) Among social determinants, education is fundamental, because education forms the new members of society – children and youth. Effective teachers are facilitators of long-term health benefits. Beyond school health promotion, education as a means of public health intervention is more difficult to define, to administer, to measure, and to evaluate. It is cumulative, formative, and transformative, both for the individuals who experience it and for the society it recreates and modifies. Although these features make education more challenging than some other tools of public health, such challenges must not deter the public health community from working closely with the education community to investigate and understand this form of social determinant causation, evaluate the wide array of educational program types, and mobilize for action on this powerful force for public health benefits.

Acknowledgments

Many thanks to thoughtful readers and editors Randy Elder, Catherine Ross, Barbara Rimer, Kate W. Harris, Amy Brown, Heba Athar, and Kristen Folsom.

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Biographies

Robert A. Hahn received his PhD in anthropology at Harvard University (1976) and his MPH in epidemiology from the University of Washington (1986). Since 1986, he has served as an epidemiologist at the US Centers for Disease Control and Prevention (CDC) in Atlanta and is a member of the Senior Biomedical Research Service. He is the author of Sickness and Healing: An Anthropological Perspective (1995) and co-editor of Anthropology and Public Health: Bridging Differences in Culture and Society (2008), with a second edition recently published. In 1998–1999, he worked as a Capitol Hill Fellow in the US House of Representatives Committee on Veterans Affairs and in the office of Congresswoman Louise Slaughter. He is currently coordinating scientist of systematic reviews on health equity for the CDC Guide to Community Preventive Services .

Benedict I. Truman earned his BS in chemistry and MD from Howard University and his MPH from the Johns Hopkins Bloomberg School of Public Health, where he completed a residency in preventive medicine and public health and served as chief resident. He has held scientific and leadership positions in state, local, and federal public health agencies and is the associate director for science at the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the US Centers for Disease Control and Prevention (CDC). In this role, he works with other scientists and program managers to ensure that the CDC’s scientific products and research ethics meet the highest standards of quality and integrity. He has published many peer-reviewed journal articles on educational interventions for health equity; prevention and control of infectious diseases and chronic noninfectious diseases; adolescent and school health; community preventive services guidelines; minority health and health disparities; employee performance and public health workforce development; and applied epidemiologic methods. He serves as the Consulting Editor for Infectious Diseases for the Journal of Public Health Management and Practice .

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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The purpose of this list is two-fold:

• To provide sources of current awareness in general and disciplinary teaching and learning scholarship
• To provide suggested venues for publication outside of the literature of library and information science

For instruction librarians in an academic setting, there is value in keeping current with teaching and learning scholarship reported in the literature of library and information science but also higher education and other academic disciplines. In addition, librarians who plan to publish pedagogical articles may find it helpful to identify other journals outside the library field with this focus, in order to speak to teaching faculty. For these reasons, the ACRL Instruction Section Research & Scholarship Committee provides here a selective list of teaching and learning journals that focus on instructional strategies in higher education. Journals included in the list are:

• English language
• focused on higher education
• focused on teaching and learning

This list is updated every three years. The following categories were selected and annotated in 2024. For a listing of journals by discipline, see the list maintained by the Center for Teaching and Learning at UNC Charlotte. 

Categories:

First-year experience

Reading / reading strategies, project-based learning (pbl) and active learning , service learning and community engagement , inclusive teaching.

Note: [OA]   = Open Access Publications [POA] = Partial Open Access or Hybrid Publications

• College Teaching [POA]: An interdisciplinary forum on issues in teaching and learning at the undergraduate or graduate level, this journal publishes three kinds of articles, full length articles, quick fix articles, and commentaries. 
• Journal on Empowering Teaching Excellence  [OA]: A bi-annual publication by Utah State University that provides practical and experience-based insights from higher education professionals. Topics include student engagement, teaching and learning evaluation, and instructional design. 
•  Journal on Excellence in College Teaching : Published at Miami University by and for faculty who are interested in sharing innovative pedagogies and in increasing student learning through effective teaching.
• Journal of the Scholarship of Teaching and Learning [OA]: Founded by Indiana University’s Faculty Academy on Excellence in Teaching, this journal highlights empirical research, case studies, essays, critiques, and articles of a theoretical/conceptual nature.
• New Directions for Teaching and Learning : Offers a comprehensive range of ideas and techniques for improving college teaching based on the experience of seasoned instructors and the latest findings of educational and psychological researchers.
• College Student Affairs Journal [OA]: Publishes 5500–7000 word original qualitative and quantitative research articles on topics of interest to student affairs practitioners, graduate students and faculty.
• Journal of College Orientation, Transition, and Retention [OA]: Publishes theoretical and empirical articles, how-to articles, and reviews related to the matriculation, orientation, transition, and retention of college students of up to 30 pages. The target audience is higher education professionals working in orientation, transition, retention and student affairs.
• Journal of College Student Development [POA]: Publishes 5-30 page scholarly articles and reviews about college students from student affairs, higher education, sociology, psychology, social work, nursing, business administration, and health sciences.
• Journal of Postsecondary Student Success [OA]:Publishes interdisciplinary peer-reviewed theory, research, policy, and practice related to student success in higher education. The target audience is researchers, practitioners, and policy makers, and articles may be up to 10,000 words depending on type.
• Journal of The First-Year Experience & Students in Transition : Publishes empirical studies of up to 30 pages on student transitions within post-secondary education. The target audience is college educators from all disciplines/backgrounds.
• Journal of Adolescent and Adult Literacy [POA]: Publishes original research, literature and media reviews, commentaries, and discussions on theory and practice of teaching literacy. Content covers learners from age 12 and up. 
• Journal of College Reading and Learning : Publishes original research articles up to 6,000 words that focus on college students’ experiences with “reading, writing, thinking, and studying,” as well as strategies to teach sub-populations, and program evaluations.
• Journal of Research in Reading [POA]: Publishes empirical research and review articles that focus on the psychological and educational approaches of reading, spoken language and writing. Subjects may be children or adults. 
• Reader: Essays in Reader-Oriented Theory, Criticism, and Pedagogy [POA]: Hosted by Lafayette College, Pennsylvania, this journal publishes research essays and articles from a variety of disciplines, including reading research. 
• Reading Psychology : Publishes original research, experiential or philosophical explorations, theoretical pieces, practitioner accounts, and literary or humorous pieces encompassing the fields of reading, literacy, and associated psychology disciplines. Double-anonymous peer-reviewed.
• Reading Research Quarterly [POA]: Publishes original research articles and commentaries, reviews, and theoretical and methodological essays on reading and literacy. 
• Active Learning in Higher Education [POA]: This international journal, published by Sage, provides a platform for publishing research about effective teaching, learning and assessment across higher education disciplines. It publishes articles, registered reports and replication studies.
• American Society for Engineering Education [OA]: ASEE hosts a variety of conferences focused on engineering education in K-12 and higher education settings, providing a platform for publication on PBL and active learning as related to engineering or scientific educational settings. All papers are published in their PEER repository .
• Interdisciplinary Journal of Problem Based Learning [OA]: Hosted by Indiana University, this journal provides an outlet for research on all aspects of problem based learning in both K-12 and higher education settings. The journal accepts original research from across disciplines that will enhance the understanding of both scholars and practitioners.
• International Journal of Educational Research [POA]: IJER provides a platform for research across the field of Education for practitioners, researchers and policy makers with an emphasis on papers that are of international significance.
• Journal of Problem-Based Learning [OA]: This interdisciplinary journal contains articles on both PBL and related approaches to learning, including research on theory, curriculum design and implementation. It features original research, reviews, analysis, accounts from the field, and guidelines for practitioners and commentaries.
• International Journal of Research on Service-Learning and Community Engagement [OA]: Published annually by the International Association for Research on Service-Learning and Community Engagement. Publishes research articles, theoretical or conceptual articles, and research reviews that focus on an area of scholarship in one of the five sections of the journal.
• Journal of Community Engagement and Scholarship [OA]: Published by the University of Alabama Division of Community Affairs. Editors welcome a wide variety of academic approaches, writing styles, and methodologies in three peer-reviewed sections (regular manuscript, research from the field, book reviews) and two additional sections (community perspectives, student voices).
• Journal of Higher Education Outreach and Engagement [OA]: Quarterly publication from the University of Georgia. Publishes research articles, reflective essays, descriptions of early-stage university-community projects, book reviews, and dissertation overviews. 
• Journal of Service Learning in Higher Education [OA]: Published by the University of Louisiana at Lafayette, this journal publishes original research about methodologies and pedagogical approaches of institutional-community partnerships.
• Michigan Journal of Community Service Learning [OA]: One of the most well-respected journals in service-learning and community engagement, it focuses on research, theory, and pedagogy in academic service-learning, campus-community partnerships, civic engagement, and engaged or public scholarship in higher education.
• Equity and Excellence in Education [POA]: peer reviewed research articles and analytical essays that advance and/or complicate existing conceptualizations and understandings of equity, excellence, and justice across the field of education in the US or global contexts.
• International Journal of Inclusive Education [POA]: original, multi-disciplinary research on inclusive education, pedagogies, curricula, organizational structures, policy-making, administration and cultures.
• Journal of Diversity in Higher Education : empirical research with a special focus on issues related to diversity, equity, and inclusion as well as issues related to teaching and learning  in post-secondary environments.
• Journal of First-Generation Student Success : focuses on the experiences and outcomes of first-generation college students.
• Journal of Women and Minorities in Science and Engineering  [POA]: explores feminist teaching methods, black student/white teacher interactions, and cultural phenomena through the lenses of accessibility and interdisciplinarity.

This document is maintained by the  Research and Scholarship Committee   and was researched and compiled by the 2023-2024 members of the ACRL IS Research & Scholarship Committee. Updated: March 2024

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• Published: 03 June 2024

Evaluating competency-based medical education: a systematized review of current practices

• Nouf Sulaiman Alharbi 1 , 2 , 3  

BMC Medical Education volume  24 , Article number:  612 ( 2024 ) Cite this article

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Few published articles provide a comprehensive overview of the available evidence on the topic of evaluating competency-based medical education (CBME) curricula. The purpose of this review is therefore to synthesize the available evidence on the evaluation practices for competency-based curricula employed in schools and programs for undergraduate and postgraduate health professionals.

This systematized review was conducted following the systematic reviews approach with minor modifications to synthesize the findings of published studies that examined the evaluation of CBME undergraduate and postgraduate programs for health professionals.

Thirty-eight articles met the inclusion criteria and reported evaluation practices in CBME curricula from various countries and regions worldwide, such as Canada, China, Turkey, and West Africa. 57% of the evaluated programs were at the postgraduate level, and 71% were in the field of medicine. The results revealed variation in reporting evaluation practices, with numerous studies failing to clarify evaluations’ objectives, approaches, tools, and standards as well as how evaluations were reported and communicated. It was noted that questionnaires were the primary tool employed for evaluating programs, often combined with interviews or focus groups. Furthermore, the utilized evaluation standards considered the well-known competencies framework, specialized association guidelines, and accreditation criteria.

This review calls attention to the importance of ensuring that reports of evaluation experiences include certain essential elements of evaluation to better inform theory and practice.

Peer Review reports

Medical education worldwide is embracing the move toward outcome-based education (OBME) [ 1 , 2 ]. One of the most popular outcome-based approaches being widely adopted by medical schools worldwide is competency-based medical education (CBME) [ 3 ]. CBME considers competencies as the ultimate outcomes that should guide curriculum development at all steps or stages—that is, implementation, assessment, and evaluation [ 3 , 4 , 5 ]. To embrace CBME and prepare medical students for practice, medical educators usually utilize an organized national or international competency framework that describes the abilities that physicians must possess to meet the needs of patients and society. There are numerous global competency frameworks that reflect the characteristics of a competent doctor, for example, CanMEDS, Scottish Doctor, Medical School Projects, ACGME Outcome Project, the Netherlands National Framework, and Saudi Meds [ 1 , 6 , 7 , 8 ].

With the worldwide implementation of CBME and availability of different competency frameworks, educators are expected to evaluate various modifications made to existing medical curricula [ 9 , 10 ]. Such evaluation is intended to explore whether the program is operating as planned and its outcomes are achieved as intended in comparison to predetermined standards as well as to ensure improvement [ 11 , 12 , 13 ]. Furthermore, program evaluation revolves around two main concepts, that is, merit and worth [ 12 , 14 ]. In 1981, Guba and Lincoln explained that the merits of a program are intrinsic, implicit, and independent and do not refer to a specific context or application, while evaluating a program’s worth entails judging the value of any aspect of it in reference to a certain context or precise application [ 12 , 14 ].

To enable educators to determine the merits and worth of an educational program or curriculum, evaluation experts have proposed several models [ 14 , 15 ]. Evaluation models are guiding frameworks that demonstrate what appropriate evaluation looks like and detail how it should be designed and implemented [ 16 ]. Although almost all evaluation models focus on exploring whether a program attains its objectives, they vary in numerous aspects, including their evaluation philosophy, approaches, and the specific areas that they encompass [ 17 ].

It is essential that educators choose a suitable evaluation model when they implement CBME, as the right model will enable them to pinpoint [ 15 , 18 , 19 ]. In other words, a program helps identify areas of success, challenges, and opportunities for improvement in CBME implementation, leading to a deeper comprehension of CBME strategies and their effectiveness. Moreover, implementing CBME demands significant efforts and a wide range of financial, human, time, and infrastructure resources [ 20 ]. Thus, ensuring that these efforts and resources are well utilized to enhance educational and healthcare outcomes is crucial. In addition, evaluation provides valuable evidence for accreditation, quality assurance, policies, and guidelines. Otherwise put, it supports informed decision-making on many levels [ 21 ]. On another front, sharing evaluation results and being transparent about evaluation processes can enhance public trust in available programs, colleges, and universities [ 19 ]. However, deciding which evaluation model to adopt can be challenging [ 9 ].

Not only can it be difficult to select an appropriate model to evaluate a CBME program, but CBME evaluation itself has numerous challenges, particularly given the lack of a common definition or standardized description of what constitutes a CBME program [ 9 , 22 , 23 ]. The complexity of CBME further tangles evaluation efforts, given the multilayered nature of CBME’s activities and outcomes and the need to engage a wide variety of stakeholders [ 11 ]. Moreover, the scarcity and variable quality of reporting in studies focusing on the evaluation of CBME curricula exacerbate these challenges [ 24 ]. Furthermore, few published articles provide a comprehensive overview of available evidence on the topic.

This review is therefore designed to synthesize the findings of published studies that have reported CBME evaluation practices in undergraduate and postgraduate medical schools and programs. Its objective is to explore which CBME program evaluation practices have been reported in the literature by inspecting which evaluation objectives, models, tools, and standards were described in the included studies. In addition, the review inspects the results of evaluations and how they were shared. Thus, the review will serve in supporting educators to make evidence-based decisions when designing a CBME program. In addition, it will provide a useful resource for educators to embrace what was done right, learn from what was done wrong, improve many current evaluation practices, and compare different CBME interventions across various contexts.

Following a preliminary search within relevant journals for publications addressing evaluation practices utilized to assess competency-based curricula in medical education, the researcher used the PEO (participant, educational aspect, and outcomes) model to set and formulate the search question [ 24 ] as follows: participants : healthcare professionals and healthcare profession students; educational aspect : CBME curricula; outcome : program evaluation practices.

Next, the researcher created a clear plan for the review protocol. This review is classified as a systematized review rather than a systematic review [ 25 ]. While it does not meet the criteria for a systematic review because it relies on a single researcher and does not evaluate the quality of the studies included, it adheres to most of the steps outlined in the “Systematic Reviews in Medical Education: A Practical Approach: AMEE guide 94” [ 26 ]. Moreover, the researcher met with a medical educator with a strong background in CBME, an expert in review methods, and a librarian who is an expert in available databases and provided guidance and support for navigating such databases. Feedback was obtained from all three and used to finalize the review protocol. The protocol was followed to ensure that the research progressed in a consistent and systematized manner.

For this review, full-text articles published in peer-reviewed journals in English from 1 January 2000 to 31 December 2022 were searched within the following electronic data bases: PubMed, ERIC, Education Source, and CINHAL. The following terms were utilized to conduct the search: (Competency Based Medical Education OR Outcome Based Medical Education) AND (Evaluation OR assessment) AND (Undergraduate OR Postgraduate) AND (Implementing OR Performance OR Framework OR Program* OR Project OR Curriculum OR Outcome) (Additional file 1 ).

The researcher included articles that were published in English and reported evaluation practices for CBME or OBME curricula whether for undergraduate or postgraduate healthcare professionals. The researcher did not consider research reviews, commentaries, perspective articles, conference proceedings, and graduate theses in this review. In addition, articles that addressed students’ assessments rather than program evaluation were not included. Furthermore, articles that focused on teaching a particular skill (e.g., communication skills) or specific educational strategies (e.g., the effectiveness of Problem Based Learning) were excluded from this review.

To facilitate the screening of articles and ensure the process was properly documented, an online review software that streamlines the production of reviews (Covidence) was utilized, and all the lists of articles retrieved from the specified databases were uploaded to the tool website (available at www.covidence.org ). The tool set the screening to start with the titles and abstracts then to proceed to full texts. During these stages, the reasons for excluding an article were precisely noted. Moreover, the PRISMA diagram (available at http://www.prisma-statement.org/ ) was produced by Covidence to illustrate the process of screening and including articles in this review.

After the decision was made to include an article, a data extraction tool created for the purpose of this review was used (Additional file 2 ). Since the term “program evaluation practices” is general and does not clearly define the method or focus of the analysis involved in critiquing evaluation efforts, the analysis of available evaluation practices in this review was based on the Embedded Evaluation Model (EEM) provided by Giancola (2020) for educators to consider when embedding evaluations into educational program designs and development [ 27 ]. The EEM outlines several steps. In the first step, “Define,” educators are expected to build an understanding of the evaluated program, including its logic and context. In the second step, “Plan,” educators must establish the evaluation-specific objectives and questions and select the model or approach along with the methods or tools that will be utilized to achieve those objectives. The next step, “Implement and Analyze,” requires educators to determine how the data will be collected, analyzed, and managed. In the fourth step, “Interpret the Results,” educators are expected to derive insights from the results in terms of how the evaluation can help with resolving issues and improving the program as well as how the results should be communicated and employed. Finally, in the “Inform and Refine” step, educators should focus on applying the results to realize improvements to the program and promote accountability [ 27 ].

In addition to supporting the aim of the current review, the theoretical insights from Giancola (2020) help to ensure alignment with best practices in curriculum evaluation. Thus, for each article, the extraction tool collected the following information: the author, the publication year, the country and name of the institution that implemented the CBME curriculum, the aim and method of the article, the type of curriculum based on the health profession specialty (e.g., medicine, nursing), the level of the curriculum (postgraduate or undergraduate), the evaluation objective, the approach/model or tool, the evaluation standard, the evaluation results, and the sharing of the evaluation results. The extracted information points are essential to contextualize the evaluation and allow educators to make sense of it and adapt or adjust it to their own situations. Understanding the context of an evaluation is important considering the wide variety of available educational environments, the diversity of evaluators, and the differences in goals, modes, and benchmarks for evaluation, all of which influence how an evaluation is framed and conducted [ 27 ].

The author, publication year , and name and country of the institution that implemented the CBME curriculum provide identifiers for the original article and enable educators to seek further information about a study. The aim and method of the article were highlighted because they clarify the general context in which the evaluation was conducted. For example, this information can help educators understand whether an evaluation was carried out as a single action in response to a certain problem or was a phase or part of a larger project. The type of curriculum based on the health profession specialty (e.g., medicine, nursing) along with the level of the curriculum (postgraduate or undergraduate) have specific implications related to the nature of each specialty and the level of the competencies associated with the advancement of the program. All of the previously mentioned information is vital for educators to define and understand the program they are aiming to evaluate, which is the first step in the EEM. The evaluation objective , approach/model or tool , evaluation standard , evaluation results , and sharing of the evaluation results help to answer the research question of the current review by dissecting various aspects of the evaluation activities. In addition, the reporting of these aspects provides valuable insight into evaluation directives, plans, and execution. For educators, the evaluation objective usually clarifies the focus of the evaluation (e.g., how the program was implemented, the action done to execute education or outcomes of the program, and its effectiveness). The approach/model or tool of an evaluation is a core element of the design and implementation of the evaluation, as it determines the theoretical guidelines that underlie the evaluation and the practical steps for its execution. Based on the evaluation standard, which refers to the target used to compare the evidence or results of the evaluation, educators can judge the relevance of the evaluation to their own practices or activities. This information aligns with steps two and three of the EEM. The evaluation results are the results of the evaluation, which form the cornerstone for emerging solutions or future improvements. Finally, sharing the evaluation results , or communicating the evaluation, is a key part of handling the results and working toward their application. This information is aligned with steps four and five of the EEM.

Search results

Searching the identified databases revealed a total of 640 articles, and 183 total duplicates were removed. A total of 457 articles was considered for screening (371 PubMed, 13 ERIC, 23 Education Source, 50 CINHAL) (Fig.  1 ). Of those articles, 87 were retrieved for full-text screening. Ultimately, 38 studies met the inclusion criteria and were considered eligible to be included in the current review.

Flowchart illustrating the process of including articles in the review

Findings of the included studies

The 38 studies that met the inclusion criteria were published between 2010 and 2021, and the majority (15%; n  = 6) were published in 2019. The studies represented the following countries: Canada (37%, n  = 14) [ 10 , 11 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ], USA (27.5%, n  = 11) [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ], Australia (5%, n  = 2) [ 51 , 52 ], China (5%, n  = 2) [ 53 , 54 ], Dutch Caribbean islands (2.5%, n  = 1) [ 55 ], Germany (2.5%, n  = 1) [ 56 ], Guatemala (2.5%, n  = 1) [ 57 ], Korea (2.5%, n  = 1) [ 58 ], the Netherlands (2.5%, n  = 1) [ 59 ], New Zealand (2.5%, n  = 1) [ 60 ], The Republic of Haiti (2.5%, n  = 1) [ 61 ], Turkey (2.5%, n  = 1) [ 62 ], and the region of West Africa (2.5%, n  = 1) [ 63 ].

According to the evidence synthesized from the included studies, most of the evaluation practices were reported in competency-based curricula that targeted the level of postgraduate professionals (57%, n  = 22) and were medical in nature (71%, n  = 27) (Fig.  2 ).

Curricula specialties in included articles

The findings showed that 37% ( n  = 14) of the articles did not report the precise objective of evaluating the curriculum. Moreover, 84% ( n  = 32) did not report the evaluation approach or model used to assess the described curricula. The approaches or models reported include Pawson’s model of realist program evaluation [ 37 ], theory-based evaluation approaches [ 10 ], Stufflebeam’s context, inputs, processes, and products (CIPP) model [ 62 ], the concerns-based adoption model, sensemaking and outcome harvesting [ 33 ]the CIPP model [ 48 ], and quality improvement (QI) for program and process improvement [ 50 ]. On the other hand, a wide variety of evaluation tools was reported including observations (3%, n  = 1) [ 28 ] surveys or questionnaires (58%, n  = 22) [ 10 , 28 , 29 , 31 , 34 , 35 , 36 , 38 , 39 , 41 , 42 , 45 , 49 , 50 , 51 , 52 , 53 , 55 , 56 , 58 , 59 , 63 ] interviews (16%, n  = 6) [ 10 , 28 , 37 , 41 , 47 , 62 ], focus groups (13%, n  = 5) [ 35 , 37 , 41 , 50 , 59 ], historical document review or analysis (8%, n  = 3) [ 10 , 29 , 33 ], educational activity assessment or analysis of the activity by separate reviewers (5%, n  = 2) [ 55 , 61 ], stakeholder discussions or reports about their inputs (5%, n  = 2) [ 43 , 44 ], curriculum mapping (3%, n  = 1) [ 32 ], feedback from external reviews from accrediting bodies (3%, n  = 1) [ 32 ], the Dundee Ready Education Environment Measure (DREEM) (3%, n  = 1) [ 56 ], and students’ or participants’ assessments (5%, n  = 2) [ 38 , 46 ].

Of the studies, 37% ( n  = 14) utilized multi methods [ 10 , 28 , 29 , 30 , 32 , 34 , 35 , 37 , 38 , 41 , 48 , 52 , 56 , 59 ]. Furthermore, 7.8% ( n  = 3) of the studies reported the nature of the tool, for example, quantitative or qualitative, without specifying the exact tool utilized [ 57 , 60 ]. Moreover, 63% ( n  = 24) of the studies included in this review did not report the evaluation standards applied while assessing the competency-based curricula addressed. Yet, those studies that reported their standards were stated in various ways as follows: some publications referred to the standards of specific specialized associations or societies, such as the American Academy of Family Physicians and College of Family Physicians Canada [ 61 ], Royal Australian and New Zealand College of Psychiatrists [ 60 ], and The American Association of Occupational Health Nurses [ 45 ]. Other publications utilized known competency frameworks as their standards, such as CanMED [ 36 , 37 , 59 ], or the competencies of the American Board of Surgery [ 43 ] Association of Canadian Faculties of Dentistry [ 31 ], Royal College of Ophthalmologists [ 52 ], The Florida Consortium for Geriatric Medical Education [ 50 ], or the Dutch Advisory Board for Postgraduate Curriculum Development for Medical Specialists [ 59 ]. Furthermore, many of the publications referred to accreditation standards, such as the Accreditation Standards of the Australian Medical Council [ 51 ], Competencies of Accreditation Council for Graduate Medical Education [ 43 ], Accreditation Body in the Competency-based Curriculum [ 32 ], and the Commission on Dental Accreditation of Canada [ 31 ]. All the publications included in the review reported the results of their evaluations.

Finally, the results revealed that almost half (52.6%, n  = 20) of the authors of the articles mentioned that they were publishing their experience with the intent of sharing lessons learned, yet they did not refer to any other means of sharing the results of their evaluations. In contrast, the other half did not mention any measures taken to communicate and share the evaluation results. Additional file 3 includes the characteristics and details of the data extracted from the studies included addressing evaluation practices in healthcare professionals’ education.

Evaluating a curriculum appropriately is important to ensure that the program is operating as intended [ 13 ]. The present study aimed to review the available literature on the evaluation practices of competency-based undergraduate and postgraduate health professionals’ schools and programs. This review inspected which evaluation objectives, models, tools, and standards were described as well as the results of evaluations and how the results were shared. The synthesized evidence indicates that most of the programs reporting evaluation practices were postgraduate-level medical programs. This focus on CMBE among postgraduate programs can be related to the fact that competency-based education is organized around the most critical competencies useful for health professionals after graduation. Thus, they are better judged at practice [ 64 , 65 , 66 ]. Moreover, although competency-based curricula were introduced to many health professions over 60 years ago, such as pharmacology and chiropractic therapy, within the medical field they have only evolved in the last decade [ 67 ].

Furthermore, the data revealed that there is a discrepancy in how evaluation practices were reported in the literature in terms of evaluation objectives, approaches/models, tools, standards, documenting of results, and communication plans. Each area will be further discussed in the following paragraphs considering the ten-task approach and embedded evaluation model [ 27 , 68 ]. Both guide evaluation as an important step in curriculum development in medical education, detail the evaluation process, and outline many important considerations from design to execution [ 27 , 68 ].

Evaluation is a crucial part of curriculum development, and it can serve many purposes, such as ensuring attaining educational objectives, identifying areas of improvement, improving decision-making, and assuring quality [ 13 , 27 ]. Consequently, when addressing evaluation, it is important for educators to start by explaining the logic of the curriculum by asking, for example, what the program’s outcomes are and whether it is designed for postgraduates or undergraduates [ 27 ]. Moreover, educators must be precise in setting evaluation objectives, which entails answering certain questions: who will use the evaluation data; how will the data be used at both the individual and program level; will the evaluation be summative or formative; and what evaluation questions must be answered [ 27 , 68 , 69 ] However, many of the studies included in this review did not clearly explain the context of the curricula or report the objectives of their evaluation endeavors; rather, they settled for clarifying the objectives of the study or of the publication itself. One reason for this is that evaluation and educational research have many similarities [ 13 ] Nevertheless, the distinction between the two should be clarified, as doing so will enable other medical educators to better understand and benefit from the evaluation experience shared. Moreover, since CBME outcomes are complicated and should be considered on many levels, evaluation plans should include a focus, level, and timeline. The focus of an evaluation can be educational, with outcomes relevant to learners, or clinical, with health outcomes relevant to patients. The level of an evaluation can be micro, meso, or macro, targeting an individual, a program, or a system, respectively. The timeline of an evaluation can investigate outcomes during the program, after the program (i.e., how well learners have put what they learned in a CBME program into practice), and in the long term (i.e., how well learners are doing as practicing physicians) [ 70 ].

Once the evaluation objectives are clearly identified and prioritized, it is logical to start considering the evaluation approach or model that is most appropriate to attain these objectives considering the available resources. In other words, evaluation design should be outlined [ 27 , 68 ]. The choice of an evaluation approach or model affects the accuracy of assessing certain tasks carried out by or to specific subjects in a particular setting [ 68 , 71 , 72 , 73 , 74 , 75 ] This accuracy is referred to as an evaluation’s internal validity. Yet, the external validity of an evaluation entails that the evaluation results are generalizable to other subjects and other settings [ 68 ]. Each model has its own strengths and weaknesses, which require careful examination when planning an evaluation [ 14 , 73 , 74 , 75 ]. Explaining and justifying why a particular evaluation approach was chosen for a specific curriculum can enrich the lessons learned from the evaluation and aid other educators. Furthermore, some of the available models were more utilized within various educational contexts than others [ 17 ] that calls for a continuous documentation of the evaluation approaches or models used to inform theory and practice. Considering the importance of reporting the approaches and models used, it is unfortunate that most of the publications did not indicate the approach/model they used for evaluation, which limits educators’ abilities to utilize the plans and build on their evidence.

Another critical task in the evaluation process is deciding on the measurement tool or instrument to be used. The tool choice will determine what data will be gathered and how they will be collected and analyzed [ 27 , 68 ]. Thus, the choice should consider the evaluation objective as well as the uses, strengths, and limitations of each tool. The evidence in this review indicates that questionnaires or surveys were the most utilized tools in evaluating competency-based curricula. This result can be attributed to the advantages of this method (for example, it is a convenient and economical tool that is easy to administer and analyze and can be utilized with many individuals) [ 27 , 68 ]. Nevertheless, it is important to highlight that questionnaires and surveys usually target attitudes and perceptions, which usually entails only a surface-level evaluation, according to the Kirkpatrick model [ 76 ]. The results also showed that in around 50% of the mixed-methods evaluations, the questionnaires were combined with another tool, such as interviews or focus groups. Understandably, utilizing an additional tool aims to deepen the level of the evaluation focus to include learning, behaviors, or results [ 76 ].

The evaluation evidence must be compared with a standard or target for educators to judge the program and make decisions [ 12 ]. Standards can be implicit or explicit, but they usually provide an understanding of what is ideal [ 12 ]. Worryingly, the results of this review revealed that many of the included studies did not clarify the standards they used to judge different CBME curricula. However, the studies that reported their standards used accreditation criteria or broad competencies frameworks, such as CanMeds, which consider the guides of specialized associations, such as family physicians or nursing. Although deciding what standard to use can be challenging to those designing and evaluating programs, evaluating without an understanding of the level of quality desired can lead to many complications and a waste of resources.

Communicating and reporting evaluation results are crucial to attaining the evaluation objectives [ 27 , 68 , 75 ]. Moreover, effective communication strategies have many important functions, such as providing decision makers with the necessary data to make an informed decision. Informing other stakeholders about the results is also important to achieve their support in implementing program changes and nourish a culture of quality [ 77 , 78 ]. Around half of the authors of studies included in this review indicated that they were publishing to share their own evaluation experiences, while the other half did not. Regardless, none of the studies shared or indicated how their results were reported and communicated, which is an important part of the evaluation cycle that should not be overlooked when sharing evaluation lessons within the scientific community. Reporting the results also ensures quality transformation by closing the evaluation cycle and encourages future engagement in evaluation among different stakeholders [ 78 , 79 , 80 ]. Moreover, the results of the evaluation should be shared publicly to contribute to increasing public trust in educational programs and their outcomes [ 19 , 69 ].

In summary, this review of evaluation practices within competency-based curricula for undergraduate and postgraduate health professional programs provides valuable insight into the current landscape. The results of the review show that most evaluation practices published pertain to postgraduate medical programs. In addition, by examining the objectives, models, tools, standards, and communication of evaluation results, this study exposes a discrepancy between the reported evaluation practices and identified evaluation elements. This discrepancy extends to the data that are reported, which makes it even more difficult to synthesize a holistic picture and definitively fulfill the aim of the review. Moreover, the issue of missing information poses serious challenges for educators who try to leverage existing knowledge to inform their curriculum development and improvement efforts, and it highlights the need for a more systematic and transparent approach to evaluation within CBME.

This review illustrates the importance of agreeing on the main evaluation elements to be reported when publishing a CBME evaluation. Establishing a shared understanding of these fundamental elements will give educators a framework for enhancing the practical utility of evaluation methodologies. In addition, educators and practitioners can ensure that the evaluation process yields more insightful outcomes and is better tailored to meet the needs of the educational context.

Data availability

The datasets used during the current study are available from the corresponding author on reasonable request.

Abbreviations

Outcome-Based Medical Education

Competency-Based Medical Education

Embedded Evaluation Model

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The author would like to acknowledge the support that Prof. Ahmad Alrumayyan and Dr. Emad Masuadi gave this research by reviewing its protocol and providing general feedback. In addition, the author would like to acknowledge Dr. Noof Albaz for the discussions about educational program evaluation, which contributed to improving the final version of this manuscript. Thanks, are also due to Mr. Mohammad Alsawadi for reviewing the utilized search terminologies and participating in the selection of appropriate databases and searching them to obtain the needed lists of articles.

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• Construction and Civil Engineering (Civil Engineering, Construction Technology & Management; Urban & Regional Planning, architecture); and,
• Electrical Engineering & Informatics (Electrical Engineering, networking, and Communications, Biomedical & Computer Engineering; Computing, artificial intelligence, and intelligent systems, information technology, information systems);
• Other applications of physical, biological, chemical, and mathematical sciences in engineering and technological innovations.

Ethiopian Journal of Governance and Development

        ISSN (Online): 2957- 4420                                                     ISSN (Print): 2957-4412

Ethiopian Journal of Governance and Development (EJGD ) drives the discipline of governance and development towards human development and societal transformation on a scientific pattern that ensures the sustainability of nation, democracy, peace and harmony , stable and better-governed states in Africa in general, and Ethiopia in particular that play their role as building blocks for African integration t hrough disseminating knowledge of research and innovations.

Teaching-learning, Community Services, and Research are the key pillars of the higher learning institutions in the world. The Quality research output dissemination bridges the higher institutions with the society they are intended to serve by interacting and sharing new scientific findings that distinguish rationalism over irrationalism. It is on this endeavor of scientific inquiry in the vast and multifaceted areas of Governance and Development that the EJGD is launched.

In addition, the Journal is intended to provide a platform for the exchange of ideas and to constitute a depository of scholarly and scientific work of high academic standards that can contribute to design the policies and contribute to the establishment and/or consolidation of state-building, nation-building, democracy, and its institutions, good governance, development, and peace.   More specifically. the following rationale is identified:

• To carry out research on the interdisciplinary areas of governance and development in order to assist policy-makers, academicians, and public service sectors related to the development of public policies, scientific outlook, good governance, and service delivery issues.
• To provide a platform of dialogue and organize seminars, symposiums, workshops with and among stakeholders in the field of governance and development
• Working towards an enabling environment that can promote good leadership, democracy, peace, development, and corporate governance.
• To encourage the public policy dialogue on issues raised from the research

Ethiopian Journal of Medical and Health Sciences

Ethiopian Journal of Medical and Health Sciences (EJMHS) – ISSN (online): 2789-7087 – is a peer-reviewed journal published by the College of Medicine and Health Sciences of Hawassa University under a creative commons license (CC BY 4.0) . EJMHS is a multi- and inter-disciplinary journal that is devoted to publishing fascinating, high quality, state-of-the-art, and valuable advancements in the fields of medical, health, and basic sciences.

EJMHS invites submission of manuscripts from different disciplines to advance the depths of knowledge related to medical, health, and basic sciences. The journal encourages publications of scholarly papers on various themes with the aim of giving innovative solutions to health problems.

EJMHS is an open-access academic journal published biannually on a regular basis. The Journal publishes original research articles, critical reviews, mini-reviews, short communications, book reviews, and clinical case reports related to the specific theme, and a variety of special issues. It encourages publishing comments on current health initiatives; personal experiences; and comments on clinical, social, political, economic, and all other factors affecting the health status of the society.

Hawassa University Journal of Law

Hawassa University Journal of Law (HUJL) aspires to foster legal scholarship through research and inquiry into contemporary legal problems and law-related issues; and it serves as a forum for academicians, researchers, law-makers, practitioners, and policy-makers to publish their original scientific research findings. The Journal is intended for legal scholars, practitioners, government officials, and graduate and post-graduate law students. HUJL is an open-access peer-reviewed journal that annually publishes original and high-quality scholarly works since July 2017.

Journal of Forestry and Natural Resources

The journal publishes scientific articles related to social, economic, policy, and environmental aspects: forestry, agroforestry, wildlife, soil, water and land resources, renewable energy, tourism, urban forestry and greening, environmental science, GIS, and remote sensing.

JFNR accepts the following format: Research articles, Review articles, Featured articles, Short Communications and Book Reviews.

The International Journal of Indian Psychȯlogy

Fostering Inner Harmony: Ways to Enhance Psychological Well-Being

| Published: June 05, 2024

As the world continues to change and evolve, prioritizing mental health is an essential aspect for personal and collective well-being. Through a comprehensive review of literature and empirical studies, this paper examines various strategies and practices aimed at cultivating inner harmony, including mindfulness, self-compassion, and emotional regulation techniques. Many studies have shown that living a life with meaning and purpose, practice mindfulness, express gratitude, identify one’s strength, practice forgiveness, fostering relationships, yoga, a good physical health, social support and maintain a balanced lifestyle are some important factors that contribute to enhance psychological well-being. Some studies have also found that personality traits, such as openness to experience and conscientiousness were associated with higher level of psychological well-being.

Inner Harmony , Psychological Wellbeing , Enhancing Wellness

This is an Open Access Research distributed under the terms of the Creative Commons Attribution License (www.creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any Medium, provided the original work is properly cited.

© 2024, Meena, Nayal, M.L. & Kukreti, V.

Received: March 24, 2024; Revision Received: June 01, 2024; Accepted: June 05, 2024

Meena @ [email protected]

Article Overview

Published in   Volume 12, Issue 2, April-June, 2024