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The effects of prison education programs: Research findings

2014 metastudy from the RAND Corporation of correctional-education programs in the United States, summarizing their main achievements and the challenges they face.

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by Martin Maximino, The Journalist's Resource June 3, 2014

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The United States has the largest prison population in the world, with more than 2.2 million inmates in federal, state and local facilities. Although the number of life sentences has quadrupled since 1984, every year approximately 700,000 citizens leave federal and state prisons in the United States to begin a new life. Moreover, the number of releases from U.S. prisons in 2012 exceeded that of admissions for the fourth consecutive year, contributing to a slight decline in the total U.S. prison population.

The professional and personal lives of these individuals after they leave prison show great variety, across different states and income levels. Many ex-offenders struggle to reintegrate into their communities and face significant challenges in re-entering the job market. In this context, recidivism often ensues: The Pew Center on the States suggests that perhaps half of all inmates released will return within three years.

But the story of their life challenges typically begins even before conviction and prison time. A 2014 U.S. National Research Council report, authored by some of the nation’s leading criminal justice scholars, notes:

Many people enter prison with educational deficits and could benefit from education while incarcerated. Literacy rates among prisoners generally are low, and substantially lower than in the general population…. Over the past 40 years, the percentage of prisoners having completed high school at the time of their incarceration fluctuated between about one-quarter and more than one-third for state prison inmates, with higher rates for those housed in federal facilities.

The report also discusses the recent policy dynamics associated with prison education:

On a positive note, basic correctional education programs have been enhanced in response to “mandatory education laws” at both the state and federal levels, requiring prisoners who score below a certain threshold on a standardized test to participate while in prison. Since the Federal Bureau of Prisons implemented the first mandatory literacy program in the early 1980s, 44 percent of states have instituted such requirements…. On the other hand, as part of the “get tough” movement discussed earlier, in 1994 Congress restricted inmates from receiving Pell grants, which had been enacted and funded by Congress in the 1970s as a way for disadvantaged groups to obtain postsecondary education. Moreover, reductions in federal funding under the Workforce Investment Act cut funding for correctional education to a maximum of 10 percent (from a minimum of 10 percent).

A 2014 study published by RAND Corporation, “How Effective is Correctional Education, and Where Do We Go from Here?” critically analyzes results across 267 empirical studies, performing what is called research “metaanalysis.” The researchers — Lois M. Davis, Jennifer L. Steele, Robert Bozick, Malcolm V. Williams, Susan Turner, Jeremy N. V. Miles, Jessica Saunders and Paul S. Steinberg — present a rigorous and systematic review of correctional education programs in the United States, as well as the results of a national survey to state correctional education directors, summarizing the main achievements and challenges faced by the field. The overall analysis suggests that correctional education has a positive and statistically significant effect on three domains that are key for reinsertion into civil society: recidivism (going back to prison because of additional crimes), post-release employment, and reading and math scores. The RAND research is designed to provide the best available evidence to help inform federal policy, following the Second Chance Act of 2007 .

The study’s findings include:

• Inmates who participated in correctional education programs had “43% lower odds of recidivating than inmates who did not.” This represents a reduction of 13 percentage points on the risk of recidivism.
• The odds of obtaining employment after being released among inmates who participated in correctional education were 13 percent higher than the odds for those who did not. However, the scholarship in this area is not as strong, making the conclusion subject to further research.
• Correctional education is a cost effective initiative; every dollar spent on prison education could save up to five dollars on three-year reincarceration costs. In this sense, the direct costs of reincarceration are far greater than the direct costs of providing correctional education.
• The study also found that for a correctional education program to be cost-effective — or to break even — it would need to “reduce the three-year reincarceration rate by between 1.9 percentage points and 2.6 percentage points.”
• The overall “meta-analytic findings indicate that participation in correctional education programs is associated with a 13 percentage-point reduction in the risk of reincarceration three years following release. Thus, correctional education programs appear to far exceed the break-even point in reducing the risk of reincarceration.”
• Overall, the mean dollars spent per student for correctional education was $3,479 in FY2009, compared with $3,370 in FY2012. This represented a 5% decrease on average in the dollars spent per student.

The report also presents the results of the RAND Correctional Education Survey, which show that, due to the economic recession of 2008, there was an overall 6 percent decrease on average in states’ correctional education budgets between fiscal years 2009 and 2012. The largest impact on budgets was felt by medium-sized and large states (on average, a 20 percent and 10 percent decrease, respectively). Nevertheless, despite the contraction after the recession, most states (44) still offered adult basic education.

One of the most interesting contributions of the RAND study is to shift the discussion from whether these correctional educational programs should exist, to what type and quality of programs would be more effective. In this discussion, the authors identify several promising initiatives: Read 180 (for reading improvement); and Florida’s Avon Park Youth Academy (for diploma completion and post-release employment).

About The Author

Martin Maximino

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Welcome to The Journal of Prison Education Research . With a renewed focus on prison education research, we recently relaunched our journal including a new name and website. We aim to create a democratic dialogue within and across the field of prison education research.

Formerly known as The Journal of Prison Education and Reentry , the journal's archives published under that title (from 2014 to 2023) can be found at https://scholarscompass.vcu.edu/jper/

See the Aims and Scope for a complete coverage of the journal.

Current Issue: Volume 8, Issue 1 (2023)

Research papers.

Understanding Incarcerated Education: A Review of the Digital and Gender Inequality Impacts of Accessibility and Inclusivity of Higher Education for Incarcerated Students Bianca R. Parry PhD

Prisons and Universities: Co-creating curricula for prison-university partnerships. Michela Scalpello

Graying Incarcerated Persons and Education Programs in Nigerian Correctional Centre Ijeoma B. Uche PhD, Agnes E. Okafor PhD, and Okala A. Uche PhD *corresponding author

An Evidence-Based Approach To Prison Library Provision: Aligning Policy and Practice Jayne Finlay, Susannah Hanlon, and Jessica Bates

The Changing Nature of Education in Youth Justice Centres in New South Wales (Australia) Laura Metcalfe, Cathy Little Dr, Garner Clancey Dr, and David Evans Dr

Understanding the Challenges of Perspective Transformation in Prison: Biographical Narratives of Foreign National Students of a Second Chance School in Greece Antigoni K. Efstratoglou and George A. Koulaouzides

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Prison education.

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Conferences

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• Accompaniment Through Carceral Geographies: Abolitionist Research Partnerships with Indigenous Communities Laurel Mei-Singh (Antipode, 2019)
• Critiquing Critical Pedagogies Inside the Prison Classroom: A Dialogue Between Student and Teacher Erin L. Castro and Michael Brawn (Harvard Educational Review, 2017)
• Distinguishing Radical Teaching from Merely Having Intense Experiences While Teaching in Prison Robert Scott (The Radical Teacher, 2013)
• Information Needs in Prisons and Jails: A Discourse Analytic Approach Debbie Rabina, Emily Drabinski and Laurin Paradise (Libri, 2016)
• An Open Letter to Prison Educators Malakki (from Critical Perspective on Teaching in Prison, 2019)
• Ripping Off Some Room for People to "Breathe Together": Peer-to-Peer Education in Prison Simone Weil Davis and Bruce Michaels (Social Justice, 2015)
• Systemic Oppression and the Contested Ground of Information Access for Incarcerated People Jeanie Austin, Melissa Charenko, Michelle Dillon and Jodi Lincoln (Open Information Science, 2020)
• Teaching Publics in the American Penalscape Gillian Harkins and Erica R. Meiners (American Quarterly, 2016)

For more articles on prison education, please start with this search of the library catalog .

For more books on prison education, please start with this search of the library catalog .

• National Conference on Higher Education in Prison The annual National Conference on Higher Education in Prison (NCHEP) is not only an event—it's a lifeline for the community of people who are committed to expanding educational opportunities for students who are currently or formerly incarcerated.
• Rise Up Conference Rise Up Conference is a two-day virtual event organized by formerly incarcerated leaders and centered.
• American Prison Newspapers, 1800-2020: Voices from the Inside American Prison Newspapers brings together hundreds of these periodicals from across the country into one collection that will represent penal institutions of all kinds, with special attention paid to women's-only institutions.
• Mass Incarceration and Prison Studies Mass Incarceration and Prison Studies is organized around a selection of key historical and contemporary events and themes, bringing together archival and reference materials, court cases, first-hand accounts, videos, Supreme Court audio files, research on rehabilitation, training materials and artistic works.
• Alliance for Higher Education in Prison We are working collaboratively to advance the field of higher education in prison by supporting practitioners and students, producing reliable data and research, and communicating the need, importance, and value of quality higher education in prison.
• Carceral Studies Network The Carceral Studies Network hosts resources for those seeking to teach or learn about prisons, policing, and the carceral state.
• College & Community Fellowship CCF works at the intersection of racial equity, criminal legal reform, economic justice, and community building. We are one of the first organizations to focus on access to higher education for justice-involved women.
• Higher Education in Prison Research A digital space centered around the creation of a robust, ethical, and sustainable higher education in prison research infrastructure.
• JSTOR Prison Education Offline Access Initiative We aim to create a next-generation tool to support incarcerated students conducting research without access to the internet. We will test this tool at a cohort of prison education programs, in order to make a recommendation regarding how to provide full access to JSTOR to as many higher education in prison programs as possible.
• Prison-to-Professionals (P2P) Prison-to-Professionals (P2P) seeks to reach, touch, and change the lives of people with criminal convictions through advocacy, mentoring, and policy change.
• Incarceration Incarceration is a peer-reviewed, international journal publishing high quality original scholarship dealing with prisons and prison-like institutions and practices.
• International Journal for Crime, Justice and Social Democracy The International Journal for Crime, Justice and Social Democracy is an open access, blind peer reviewed journal that seeks to publish critical research about common challenges confronting criminal justice systems around the world.
• Journal of Correctional Education The Journal of Correctional Education is the foremost publication of the Correctional Education Association (CEA). The Journal is published on a quarterly basis and is provided as a membership benefit by CEA.
• Journal of Higher Education in Prison The Journal of Higher Education in Prison is the only peer-reviewed journal that publishes solely on topics and issues in higher education in prison. The journal, published twice-annually by the Alliance for Higher Education in Prison, provides the growing field of higher education in prison a forum to discuss praxis and the ways that theory can and should inform teaching and learning in prison.
• Journal of Prison Education & Reentry An international, open access, peer-reviewed journal for researchers and practitioners. Topics covered include but are not limited to sociology, criminology, adult education and literacy, instructional design, mental and behavioral health, and administration and policy as it relates to the context of prisoner education and subsequent reentry into the community beyond prison walls.
• Journal of Prisoners on Prison The Journal of Prisoners on Prisons (JPP) is a prisoner written, academically oriented and peer reviewed, non-profit journal, based on the tradition of the penal press. It brings the knowledge produced by prison writers together with academic arguments to enlighten public discourse about the current state of carceral institutions.
• The Prison Journal The Prison Journal (TPJ), peer-reviewed and published six times a year, is a central forum for studies, ideas, and discussions of adult and juvenile confinement, treatment interventions, and alternative sanctions. Exploring broad themes of punishment and correctional intervention, TPJ advances theory, research, policy and practice.
• Cultivating Relationships & Building Support: A Guide to College-in-Prison Program Sustainability Rachel Sander et al. (SUNY Higher Education for the Justice-Involved, 2021)
• The Expanding Role of Colleges in Prison Education Katherine Mangan (Chronicle of Higher Education, 2021)
• Facilitating a Higher Education in Prison Research Infrastructure Meagan Wilson, Rayane Alamuddin, Julia Karon, Michael Fried, and Emily Norweg (Ithaka S+R, 2021)
• Higher Education in Prison: Understanding its Power and Fulfilling its Promise in Illinois [PDF] By Marsheda Ewulomi and Ashton Hoselton (BPI Chicago, 2022)
• Unbarring Access: A Landscape Review of Postsecondary Education in Prison and Its Pedagogical Supports Meagan Wilson, Rayane Alamuddin, Danielle Cooper (Ithaka S+R, 2019)
• College Behind Bars A four-part documentary film series directed by award-winning filmmaker Lynn Novick, produced by Sarah Botstein, and executive produced by Ken Burns, tells the story of a small group of incarcerated men and women struggling to earn college degrees and turn their lives around in one of the most rigorous and effective prison education programs in the United States.
• The Past and Future of Prison Education Representatives from the most innovative and dynamic programs in the country testify to the range, scope, and depth of prison education. Organizers highlight the work that has been done at Harvard, and what's next.
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• Last Updated: Mar 21, 2024 9:27 AM
• URL: https://libguides.northwestern.edu/prison-education

Are Schools in Prison Worth It? The Effects and Economic Returns of Prison Education

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• Published: 21 October 2023
• Volume 48 , pages 1263–1294, ( 2023 )

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Recent expansions in prison school offerings and the re-introduction of the Second Chance Pell Grant have heightened the need for a better understanding of the effectiveness of prison education programs on policy-relevant outcomes. We estimate the effects of various forms of prison education on recidivism, post-release employment, and post-release wages. Using a sample of 152 estimates drawn from 79 papers, we conducted a meta-analysis to estimate the effect of four forms of prison education (adult basic education, secondary, vocational, and college). We find that prison education decreases recidivism and increases post-release employment and wages. The largest effects are experienced by prisoners participating in vocational or college education programs. We also calculate the economic returns on educational investment for prisons and prisoners. We find that each form of education yields large, positive returns due primarily to the high costs of incarceration and, therefore, high benefits to crime avoidance. The returns vary across education types, with vocational education having the highest return per dollar spent ($3.05) and college having the highest positive impact per student participating ($16,908).

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Introduction

Following an explosive growth in U.S. incarceration rates starting in the 1980s, more than six in every 1,000 people in the U.S. population are behind bars, the highest rate in the world, Footnote 1 despite many other countries having higher violent crime rates. A 2003 estimate by the Prison Policy Initiative projected that six percent of Americans would be imprisoned at some point in their lifetime, including almost one-third of all African Americans. Footnote 2 The decision to incarcerate relatively more people comes with direct and indirect costs. One estimate (Wagner & Rabuy, 2017 ) places the cost to house prisoners at $80.7 billion, while the costs of policing, courts, health care, and various other expenses bring the total cost to $182 billion.

The indirect costs are potentially even more extensive. Incarceration decreases rates of employment (Apel & Sweeten, 2010 ) and education for both the incarcerated (Hjalmarsson, 2008 ) and their dependents (Shlafer et al., 2017 ). Because lower education levels have been found to have a causal effect on arrest and incarceration (Lochner & Moretti, 2004 ), the decision to incarcerate a parent increases the likelihood that the child ends up in prison. Levels of social engagement (Chattoraj, 1985 ) and civic participation (Lee et al., 2014 ) are negatively affected by incarceration. Just as the direct incarceration costs increased with the prison population, these indirect costs also did. These costs can be attenuated through effective policies and programs implemented within jails and prisons. If programs in prisons can provide inmates with skills that improve their post-release outcomes, they can reduce the indirect costs of incarceration and reduce the future costs of incarceration through reduced recidivism.

For decades, the notion that incarcerated people could see their paths changed was a minority opinion. The collapse in the mid-1970s of the goal of rehabilitation gave way to the “nothing works” mindset (Martinson, 1974 ), which led to bi-partisan support for increasingly punitive prison sentences and a reduction in rehabilitation programs. The 80 s and 90 s were defined by consequent escalations in punishments, including the Sentencing Reform Act of 1984, the Anti-Drug Abuse Act of 1986, and the expansion of three-strikes laws in the 1990s. Recently, policy and public opinion have changed course: Criminal justice reforms have been passed, including the First Step Act, which eased mandatory minimum sentence rules for judges, and the re-authorization of the Juvenile Justice and Delinquency Prevention Act (both in 2018). Nonetheless, incarceration rates remain high; the Sentencing Project ( 2019 , p. 1) has described the 40-year incarceration trend as a “Massive Buildup and Modest Decline.” The incarceration rate has fallen slightly from its early 2000s peak, but this is still four times the 1970 rate. The share of Americans who feel that the criminal justice system is not tough enough has dropped by 50% since 1992, while the share who believe that the system is too tough has increased tenfold (Brenan, 2020 ). Several recent national polls – including ACLU’s Campaign for Smart Justice and Justice Action Network – show that a large majority of Americans believe rehabilitation should play a more prominent role in American criminal justice (Benenson Strategy Group, 2017 ).

One place where this reform is playing out is in prison classrooms. One of the victims of the 90 s “tough on crime” bills was educational offerings to prisoners, especially college programs. The 1994 Crime Bill eliminated the eligibility of Pell Grants for prisoners, and the rate of college participation in prison dropped from 19% in 1991 to 10% in 2004 (Sawyer, 2019 ). While college offerings have increased in the past decade (DiZerega & Eddy, 2022 ), educational opportunities beyond high school are still below their pre-1980s levels. Even programs that are offered spend a fraction of what is invested in students outside of prison. For example, Texas spends about $12,000 annually per student in the state’s public school system but only about $1,000 per incarcerated student.

The optimal education and job training policy for the incarcerated population hinges on the programs’ effectiveness. If programs are minimally effective at achieving the main goals of rehabilitation (reduction in recidivism, higher wages, or employment rates), then education programs are likely not worth the expense. However, expanding prison programs would likely be an effective public policy if the returns on investment for prison education are large.

Background and Literature Review

This study belongs to a large body of research on the effect of education and rehabilitation of the incarcerated. Much of the research has affected, or at the very least predicted, changes in policy. As noted by Smith et al. ( 2009 ), the long-held notion of American prisons as ideal homes for “resocializing” programs was called into question through Martinson’s ( 1974 ) review of the existing literature and the subsequent book covering the same data (Lipton et al., 1975 ). This research described the overall effectiveness of 231 correctional education programs operating between 1945 and 1967. Despite numerous positive effects described in their analysis (such as all studies for supervision of young parolees leading to decreased recidivism), the conclusion reached by the authors was that “nothing works” (Martinson, 1974 ).

The current study builds on several previous meta-analyses on prison education. Given the policy importance of research on prison education, the topic has been frequently studied. However, given the significant selection issues in who chooses to participate in prison education, previous meta-analyses have had to rely heavily on non-scientific comparisons or simple differences in means in their studies. Wilson et al. ( 2000 ) performed the first major meta-analysis on prison education programs a quarter-century after the work of Lipton et al. ( 1975 ). By evaluating the performance of 33 studies, their results showed that participation in an academic correctional program was associated with an 11 percent reduction in recidivism and an increased likelihood of post-release employment. They point to the need for more research that better provides unbiased estimates of causal effect, stating, “future evaluative research in this area could be strengthened through… designs that control for self-selection bias beyond basic demographic differences” (Wilson et al., 2000 , pg. 347). Similarly, Cecil et al. ( 2000 ) and Bouffard et al. ( 2000 ) find educational programs associated with better post-release outcomes while emphasizing the need for a larger pool of high-quality studies. Footnote 3

Chappell ( 2003 ) aggregated 15 studies on postsecondary prison education, finding a significant reduction in recidivism, but pointed to the small number of studies that qualified for inclusion a “disappointment” while articulating some of the issues that prevented papers from being included, such as failure to report basic statistical results (Chappell, 2003 , pg. 52). Aos et al. ( 2006 ) also performed a meta-analysis on 17 educational programs as part of a larger cost–benefit analysis of a collection of prison programs.

The most often-cited meta-analysis on prison education is by Davis et al. ( 2013 ). The authors performed a meta-analysis including 58 papers measuring the impact of corrections programs on recidivism, employment, and academic outcomes. Again, they support the findings of previous meta-analyses that participation in prison education decreases recidivism and increases employment. Moreover, as previous studies have concluded, the authors emphasize the need for higher-quality papers, stating in the forward of their paper, “This need for more high-quality studies that would reinforce the findings is one of the key areas the study recommends for continuing attention” (Davis et al., 2013 , iii). A follow-up by many of the same authors (Bozick et al., 2018 ) provides similar findings. To date, these two papers represent the best we know about the effect of prison education.

Prison education programs differ significantly across types. This means that any meta-analysis that simultaneously measures the effect of ABE, secondary education, vocational, and college programs needs an especially large sample of papers to obtain separate estimates for each type. While both Davis et al. ( 2013 ) and Bozick et al. ( 2018 ) compared the relative effectiveness of different forms of prison education, the small number of papers available meant they needed to use all papers in their sample to estimate the relative effects. However, because many papers in the samples are likely plagued by selection bias, the resulting aggregate measures will be too. Over the 21 studies analyzed by Bozick et al. ( 2018 ), they found that education increases the odds ratio of post-release Employment by 12%. However, when they restrict their sample to only Level 4 or higher papers (of which none are Level 5), their estimate of the positive impact of education actually increases, but the resulting increased standard errors render the estimates statistically insignificant. This imprecision results from only 3 of the 21 studies qualifying as a level 4 on the SMS scale. Thus, the authors conclude that the subsample provides indeterminate results.

Fogarty and Giles ( 2018 ) highlight several issues with several of the papers used in both Davis et al. ( 2013 ) and Bozick et al. ( 2018 ), such as the inclusion of papers that do not evaluate prison education or the incorrect results used, including the fact that the only two randomized trials in the meta-analyses (Lattimore et al., 1990 ) are in fact analyses of the same program. However, neither Davis et al.’s ( 2013 ) nor Bozick et al.’s ( 2018 ) broader findings are dramatically affected by correcting these mistakes.

An additional issue obfuscates the findings of both Davis et al. ( 2013 ) and Bozick et al. ( 2018 ) in broader discussions about prison education. In both cases, the authors use odds ratios to measure treatment effect (as do we). Odds ratios differ from probabilities, so a 43% decrease in the odds ratio of recidivism is not the same as a 43% decrease in the likelihood of recidivism. Davis et al. ( 2013 ) found the odds ratio for education participants is 0.57 that of non-participants. The authors carefully point out that this equates to a 13-percentage point decrease, which equates to a roughly 25% decrease. Unfortunately, Bozick et al., ( 2018 ; p. 302) fail to perform this same conversion in their analysis, where participants have a relative odds ratio of 0.68. The authors state that “inmates participating in correctional education programs are 32% less likely to recidivate when compared with inmates who did not participate in correctional education programs.” Instead, their results are consistent with a recidivism reduction of about 19%.

This confusion about odds ratios represents a common struggle with policy-relevant research: the difficulty of providing easily digestible information while conducting the rigorous statistical analysis necessary to calculate results correctly. This is one of the primary reasons we emphasize the cost–benefit analysis of our findings, which provides a relatively simple metric to evaluate the average effectiveness of money spent on each type of prison education program.

Goals & Research Question

This study focuses on the efficacy of prisoner education, including adult basic education (ABE), secondary education, higher education, and job training. What effect do these programs provide in improving outcomes for prisoners and, by extension, the public? To answer this, we conducted a meta-analysis on a large set of papers that estimated prison education’s effect. Given the decentralized nature of prison education systems, numerous studies have estimated the impact of various programs, often finding different results. A more precise causal effect estimate can be identified by pooling these effects together. For this analysis, we included papers that measured one of the following outcomes: recidivism, post-release Employment, or post-release wages. We can estimate the return on investment (ROI) for prison education by including several relevant outcome variables in a single meta-analysis.

Prison education presents numerous problems for meta-analyses. The existence of different types of programs means that many more papers are needed to determine the effects of different types of education systems, making disaggregation into smaller subsets difficult. Additionally, most studies on prison education are observational, masking the differences in outcomes between those who receive education and those who do not, with the unobserved effects of whatever drove students to get an education in the first place. Meta-analyses in medical research can solve this by focusing on randomized control trials, which address any selection bias. In social science research, such trials are rare. Instead, reliance on quasi-experimental methods is necessary, which requires researchers engaged in observational research to compare the treatment group to an otherwise similar control group, aside from differences in educational choices. By building the largest sample of papers of any meta-analysis, we can compare different types of education using only high-quality papers, which has not been possible in previous meta-analysis subsets of the papers, a crucial step given the variation in how educational programs are implemented.

Data, Sample, and Outcomes

Our sample includes papers published between 1980 and 2023 that studied the impact of prison education programs in United States prisons. We included those who conducted primary research on the effect of education and training programs (instead of the effect of having already obtained such training before entering prison). More details on the method used to find papers are provided in Appendix 2.

This paper aims to estimate the return on investment for prison education, leading us to prioritize economically quantifiable outcomes. The outcomes of interest for this analysis are recidivism (typically defined in the included papers as a return to prison), Employment, and wages. While these are not the only relevant outcomes, they are most likely to be measured by researchers and have the most direct economic benefit.

The initial search identified 750 papers for potential inclusion in the study. Of these, most (671) were eliminated for not presenting the results of an original study or for falling outside the scope of the analysis, such as studies estimating the effect of pre-incarceration education. We identified 79 papers that estimated the effect of education on one or more of our outcomes and obtained 149 separate estimates of the causal effect of prison education. Most of the novel papers in our sample have been published in the past five years after the most recent large-scale meta-analysis. However, we did identify several studies that were overlooked by previous analyses, especially less publicized studies conducted directly by various states’ Departments of Corrections.

Measures of Study Quality

Determining the quality of the studies used in the meta-analysis is critical, as empirical results can be affected by which studies are selected and the weights attached to each set of results. The Maryland Scientific Methods Scale (Farrington et al., 2003 ) has become a commonly used method of measuring study quality in the criminology field, as its grading system is catered specifically to the measure of program effect on criminal activity. The Maryland Scientific Methods Scale (SMS) provides a framework for grading studies from the lowest level of methodological rigor (level 1) to the highest (level 5). Level 1 studies, which lack a comparison group for measuring outcome differences, are omitted from our sample. Level 2 studies typically provide simple measures of the difference in the average outcomes between two groups (such as those who participated in education and those who did not). Levels 3–5 have a minimum interpretable design (Cook & Campbell, 1979 ), typically achieved with a quasi-random assignment (Levels 3–4) or random assignment (Level 5). We include all studies that earned a 2 or higher in our initial sample of papers but exclude studies scoring a 2 from our main estimates of causal effect for each education category.

Table 1 shows the breakdown of papers by outcome and SMS score. A complete list of papers identifying treatments, outcomes, and SMS scores is in Appendix 1. The recidivism sample includes 71 papers covering 102 separate estimates of causal effect, while our sample for Employment consists of 31 papers with 37 separate estimates. Footnote 4 Of the 102 recidivism estimates, 26 are graded as a 4 or 5 on the SMS scale. Eleven of the 37 employment estimates are graded as a 4 or 5. Forty-one papers with 71 separate estimates earn scores of 3 or more for our recidivism outcome, while 20 papers with 23 estimates achieve this in our employment sample. This large sample is critical to our analysis, as it allows us to compare the effects of different educational programs using only papers that scored high on the SMS score.

The sample of papers estimating the effect of education on wages is smaller, with ten papers providing 13 separate estimates of the causal effect. Despite the small number of papers estimating the effect on wages, they earn higher SMS scores. This is because papers that report standard errors are both likely to earn higher SMS scores (as they are more likely to use higher-quality methods) and more likely to be included in the wage sample.

We use random effects analysis, also called the DerSimonian-Laird method (DerSimonian & Laird, 1986 ). The primary alternative estimation strategy is fixed effects, which imposes an implicit assumption that the “true” causal effect of the intervention is common across studies. This assumption is almost certainly violated in the setting studied here, as different estimates reflect estimates of a causal effect on interventions from programs with a different method of implementation or prison populations.

Whenever possible, we used estimates of the impact of program participation instead of program completion. This has two benefits. First, the endogeneity of the decision to finish a program is likely to be strong; students who are driven enough to finish a program will likely differ from dropouts, so comparing these two groups will exacerbate omitted variable bias. Program participation is more likely to be affected by things outside prisoners’ control, such as their eligibility (e.g., based on location and reading level), and therefore is less likely to be plagued by estimation bias. Second, from a policy perspective, participation is more relevant than completion, especially since program completers are already included in the population of program participants. When we evaluate a program’s overall costs and benefits, we inherently do so against a counterfactual of no program. People who participate in the program and drop out may receive benefits anyway, and providing the education certainly costs money, so the most effective evaluation is to measure program participants (completers and non-completers) against non-participants.

In cases where the outcome variable is binary, we convert the outcome variable into an odds ratio, thereby normalizing the outcome across different studies. It is important to note that when considering odds ratios, they are not the same as absolute probabilities. Footnote 5 For example, if the odds ratio of recidivism is 0.8 for those who receive education and 1 for those without it, this does not mean that education will lead to a 20% drop in recidivism. It means that the odds ratio (defined as the probability of returning to prison divided by the probability of not returning) decreases by 20%.

When the outcome is binary, we can include studies in our analysis that presented differences in means, even if they do not report a standard error for their estimates, even though standard errors are necessary for inclusion in a meta-analysis. One characteristic of binary data is that the standard deviation of a distribution can be determined using only its mean, allowing us to back out the standard errors ourselves. Footnote 6 For our sample of studies estimating the effect of education on wages, we could only use papers that reported the standard errors or standard deviations, as we cannot back out these numbers using a simple difference in means.

When multiple recidivism horizons were measured (1 year, 2 years, 3 years), we used 3 years, as this is the most common outcome measured in the literature. Papers were not uniform in their definition of recidivism. Some papers defined recidivism by re-arrest, others by parole violations, and others by returns to prison. When papers reported multiple outcomes for recidivism, we used return to prison as the outcome variable. This is the most common outcome used by most papers in our sample.

In several studies (Anderson et al., 1991 ; Adams et al., 1994 ), the authors reported the effects of participating in multiple forms of education (such as academic + vocational). Previous meta-analyses (Bozick et al., 2018 ; Davis et al., 2013 ) included these estimates alongside the estimates of the effects of being in either academic or vocational programs. However, since this measures the effects of two doses of treatment instead of one, we incorporated these groups into a single regression, including dummy variables for both forms of education. This allows us to disentangle the separate effects.

When papers did not report standard errors, but statistical significance was reported (such as the 1 or 5-percent significance level), standard errors corresponding to that exact level of significance were selected. This is a conservative method since we will be underestimating the statistical significance of any findings. By imputing standard errors that were no smaller than the true standard errors, we avoided giving a study higher weight than is appropriate while also being able to use its findings.

Panel A of Table 2 presents the meta-analysis results across various subsamples of papers based on quality ratings. The odds ratio for recidivism is the probability that someone returns to prison divided by the probability that they do not. Using a 2021 Bureau of Justice Statistics (Durose & Antenangeli, 2021 ) estimate of 46% for the 5-year recidivism rate, the baseline odds ratio for recidivism is \(\frac{0.46}{1-0.46}=0.852.\)

As seen in the 3rd row of Panel A in Table 2 , the odds ratio for the treatment group is 0.760. This means that receiving prison education leads to a 24% decrease in the odds of recidivism. To convert this into a probability, we multiply this by the baseline odds of recidivism, \(0.852 \bullet 0.76 = 0.6475\) . An odds ratio of 0.6475 corresponds to a probability of 39.3%. This means that education decreases the probability of recidivism by 6.7 percentage points or 14.6% against a baseline of 46%. These results suggest that participation in a prison education program significantly decreases the likelihood of returning to prison.

However, this figure is an overstatement of actual causal effects, as it includes many papers that do not estimate effects using experimental or quasi-experimental methods. Therefore, we estimated the effect using only papers obtaining a 3, 4, or 5 on the Maryland SMS scale. Restricting the sample in this way is crucial for two reasons. First, these papers are more likely to avoid omitted variable bias and obtain unbiased causal effect estimates. However, an additional reason that is often overlooked in the literature is that high-quality papers are more likely to have larger standard errors because the things that make them less likely to provide biased estimates (inclusion of covariates, careful sample selection, robust or clustered standard errors) are the exact things that are likely to increase a study’s standard errors.

Using the sub-sample of high-quality papers, we find that participation in a program decreases the odds ratio of recidivism by 18.8%, which is smaller but still statistically and economically significant. If we further restrict our sample to only studies receiving a 4 or 5, we estimate education to decrease the odds of recidivism by 16.5%. This drift towards zero as we exclude papers unlikely to provide unbiased estimates suggests that the true causal effect is more likely to be 16–19 percent than 24–25 percent.

We find a drift in estimates of causal effect over time. While we find a 24% reduction in the odds of recidivism over our entire sample, this number drops to 12.4% when restricted to studies published since 2010. Some of this effect is because later papers are more likely to have more rigorous methods and, therefore, score higher on the SMS scale. As we have already seen, this leads to smaller causal effect estimates. However, the change in the composition of papers cannot explain this trend. Using just our sub-sample of studies earning SMS scores of 3 or higher, we estimate the causal effect since 2010 to be an 11% reduction in recidivism, compared to 18.8% for the entire sample. This difference has policy implications. While an 18.8% reduction in the odds ratio for recidivism is a good retrospective estimate of the effects on people who have already been released, the 11% reduction better reflects the effects of the current prison educational systems.

We also find variations in effects across educational programs. The programs evaluated in the papers studied here fall into one of the following categories: ABE, Secondary Education/GED, Vocational Education/Training, and Postsecondary Education. We estimate the effect of each kind of education program on our outcomes of interest. Given the large size of our sample, we can perform sub-group analysis while only relying on high-scoring papers (3, 4, or 5 SMS scores), supporting the claim that we can measure true estimates of a causal effect.

Panel B of Table 2 shows the differential effects of education type on reducing recidivism. We observe significant variation in the effect of education on recidivism. ABE and secondary education (high school, GED) appear to have similar effects, each leading to an 11–12 percent decrease in recidivism. Some of this similarity is due to the two groups being pooled in many estimates. The pool of papers for ABE and secondary education has 14 shared estimates, as numerous papers estimate the effect of “academic” programs, which could be either ABE or secondary programs.

Vocational education is somewhat more practical than ABE or secondary education, leading to a 15.6% decrease in the odds ratio for recidivism, but postsecondary education is where we observe the largest difference. College programs are especially effective tools for decreasing recidivism. We find that participation in a college program decreases the odds of recidivism by 41.5%. This number is so much larger than the other forms of education that point estimates for each of the other education categories fall outside the 95% confidence interval for college education. This means we can reject the null hypothesis that any other form of education is as effective as college education in reducing recidivism.

Unsurprisingly, college programs are the costliest form of intervention studied here. While other forms of education cost between $1,000 and $2,000 per year per student, college programs cost around $10,000. Bard College’s program, studied in one of the papers in this sample, costs $9,000 for each participant/year, while Pitzer College has a similar cost of $10,000. College programs also take longer to complete, meaning that not only is each participant/year more costly than other programs, but each student also participates in them for more years, further increasing the gap in the cost.

Table 3 presents the employment results. Using our entire sample of papers, we find that education increases the odds ratio of Employment by about 13.5%, which aligns with previous studies. Given baseline estimates of the percent of released prisoners employed, this equates to an increase of about 3.1 percentage points. Unlike our recidivism findings, the estimated effects of education on Employment do not depend strongly on the SMS scores of the papers used to build our sample. While we observe a decrease in our estimates when we use papers scoring 3, 4, or 5 on the Maryland scale, when we further restrict our sample to papers scoring only 4 or 5, we obtain an estimate of a 12.5% increase in the odds ratio for Employment, which is similar to that of our overall sample.

While we found the effect of education on recidivism to have dropped by more than half since 2010, our estimates of the effect of education on Employment using papers published since 2010 (a 12.4% increase) are almost the same as the estimates for the larger sample. Using our subset of papers with SMS scores of 3 or higher, the effect since 2010 (7.9%) is also similar to the 8.9% increase from the entire sample. Unlike our recidivism findings, we do not see a drift of causal effect in recent years.

Panel B of Table 3 shows the effects of different types of education on Employment. The pattern is similar to our recidivism findings. ABE and secondary education have the smallest effects. The effects are less than 3%, and both are statistically insignificant. This means that a significant uptick in observable Employment is not driving the decreased recidivism observed earlier for each of these forms of education. Vocational education has the clearest positive impact on Employment, increasing the odds of Employment by 11.8%. This further supports our recidivism findings that vocational education boosts post-release outcomes more than ABE or secondary education. We estimate that college programs increase the odds of Employment by an even larger amount (20.7%). However, the college estimate is derived from only a single study.

Finally, we turn to estimates of the effect of education on earnings. Unfortunately, our sample is much smaller due primarily to the dearth of reported standard errors in most studies. Even if studies report causal effect estimates, findings cannot be included in a meta-analysis without standard errors. Table 4 shows the sample of 13 estimates using quarterly earnings. We normalized the numbers to quarterly earnings for each estimate and inflated them to 2020 values. We find that education increases quarterly earnings by $141.

Most of the papers in the sample estimate the effect of wages only on those employed (meaning that they are dropping unemployed people from the sample). Given the small number of studies, this estimate is only significant at the 10% level. While this result may seem like a by-product of the finding that education increases Employment, it is not. People induced into the workforce by any intervention (including education) are likely to be relatively low earners, meaning that it is possible to see an increase in Employment and a decrease in wages. The fact that we see a modest wage increase means that the wage effects amplify the employment effect instead of eating away at it. While we cannot reject the null hypothesis at the 5% level that education increases wages, we can reject a null hypothesis that increased Employment is associated with lower wages. Even a small wage reduction ($15) is outside the 95% confidence interval.

Sensitivity analysis is especially important because of the number of judgments involved in meta-analyses (choice of studies to include, grading, empirical framework). We performed a series of robustness checks to determine how much these decisions affected our final findings. One primary concern for meta-analyses is publication bias. Publication bias can lead to erroneous conclusions of significant effect, even in analyses exclusively using high-quality research. If studies that find no effect are less likely to be published, a meta-analysis could conclude a significant effect even if interventions have no true effect.

We test for the existence of publication bias using a “funnel plot” and its corresponding tests (Egger et al., 1997 ). If publication bias affects the distribution of the empirical findings, we expect to see an asymmetric distribution since studies on one side of the distribution would be truncated. This would mean that studies that either found null effects or counter-intuitive ones – education increasing recidivism or decreasing employment and wages – would be less likely to be written or published, resulting in a gap in the distribution. Previous meta-analyses (Bozick et al., 2018 ; Davis et al., 2013 ) have found evidence of publication bias. Our results (see Figs.  1 , 2 and 3 ) show some evidence of publication bias for the recidivism sample (Fig.  1 ). There does appear to be a gap in the distribution on the right side of the graph, suggesting that papers finding especially large decreases in recidivism were more likely to be written and published than those finding null effects or increases in recidivism. However, the level of bias is not large enough to explain our main results for two reasons. First, the papers outside the left of the funnel are, on average, older and more likely to score lower on the SMS scale. If we restrict the sample to recent (post-2010) and high quality (3 or higher SMS score), we find no evidence of publication bias, yet we still find strong evidence that education decreases recidivism. We find little evidence of publication bias for our employment sample.

Funnel Plot Robustness Check: Recidivism

Funnel Plot Robustness Check: Employment

Funnel Plot Robustness Check: Wages

Estimating Returns on Investment

Given that prison education programs have a corresponding cost, a finding of positive effects is insufficient to support claims justifying such programs’ existence nor their expansion. It is vital to understand how these benefits compare to the costs of implementing the programs in the first place. Using a variety of estimates of costs (which we draw from various sources) and benefits (from the analysis presented here), we calculate the return on investment of education programs.

Obtaining an estimate of the cost of educating a prisoner is difficult. While many studies provide cost estimates, they almost always provide estimates of the cost of educating a student for one year, not the total cost of educating the average student. In their cost–benefit calculations, Davis et al. ( 2013 ) used estimates based on the average cost per student using a DOC annual education budget. If a student participates in programs for two or more years, the annual average cost per student will underestimate the cost of education. However, to determine the economic returns for educating a student, we also need to know how long a prisoner was taking classes.

As Aos et al. ( 2006 ) pointed out, to properly weigh the costs and benefits of different forms of prison education, we need to calculate the costs of different interventions independently. This is especially important given our findings. While college programs are the most effective, they are likely the most expensive. Many college students are completing two or four-year degrees. Compared to the average ABE length of study of 0.4 years (Cho & Tyler, 2013 ), the costs of these programs should not be expected to be comparable.

Our estimates for the cost of education are presented in Table 5 . We use a variety of papers that have provided estimates of the total costs of educating students instead of the annual costs. Because programs differ in their cost of implementation, we provide separate estimates for ABE, secondary, vocational, and college education. ABE and secondary education are often pooled together as “academic” education, so the distinction between the two is not always clear when costs are reported. They were identical in each instance where ABE and secondary education costs were reported independently.

The cost numbers show that the costs for non-college education programs are similar. Vocational education costs slightly more, but the difference is small. It would cost the same amount to provide academic education to 50 students as it would provide vocational education to 47 students. College degree programs appear to be significantly more costly to implement. The average college program costs about $10,467 for each participant, almost five times as much as the per-participant cost for vocational education.

We estimate the benefits for each group separately, given the effects found in Tables 3 and 4 . To quantify the benefits, we multiply the effects of education by the estimated marginal financial benefit using our estimates of casual effect derived from the sample of papers earning a 3, 4, or 5 SMS score. Since sample size limitations prevent us from estimating the wage effects separately for each education category, we assume that each participant experiences a boost equal to that of the sample-wide average, a $131 quarterly earnings increase.

Effects on Recidivism

Using our baseline recidivism odds ratio of 0.852, the 11% reduction in the odds of recidivism caused by ABE (as seen in Table 2 ) would lead to a 2.9 percentage point reduction in recidivism. Those decreases for secondary, vocational, and college students are 3.3, 4.17, and 12.74 percentage points, respectively. Reduced recidivism may also lead to a reduction of costs to society. For example, according to a 2015 Vera Institute study, the average cost of housing someone in a state prison was $33,274 (Mai & Subramanian, 2017 ). When inflated to 2022 dollars, that becomes $40,028. Given that most of the studies in our sample are for state or local prisons, this estimate is likely a good one for the average annual cost savings from a reduction in incarceration.

According to a recent Bureau of Justice Statistics report (Kaeble, 2021 ), the average prison stay is 2.7 years. Assuming this also reflects the average length of stay for the recidivists, the cost savings for every person deterred from recidivism due to education is $107,075 (2.7*$40,028). Therefore, taking the 2.9 percentage point decrease we found for ABE education, this would result in an average decrease in prison costs of $3,105 ($107,075*0.029). Using the 3.3 percentage point decrease for secondary education, 4.14 for vocational, and 12.74 for college, we find that education leads to prison-cost decreases of $3,533, $4,465, and $13,641, respectively.

Focusing only on the costs of crime as they relate to prison costs, we deliberately ignore the public costs of crime, including the costs to victims, police or court costs, or the costs to criminals’ families. Our decision not to include a calculation of these costs is not due to any belief that they are small but instead due to the tremendous complexity of their calculation. The cost of crime estimates varies wildly, depending on the underlying assumptions or estimation strategies researchers choose. There is also significant variation in estimates of the number of crimes committed per criminal, affecting any estimate of the costs associated with reincarceration.

Effects on Employment & Wages

For Employment, we must first consider that only those not incarcerated can be employed. According to the U.S. Department of Justice, the 3-year reincarceration rate (the most common horizon used in the employment sample) is 38.6% (Durose & Antenangeli, 2021 ). Using an estimate by the Prison Policy Initiative (Couloute & Kopf, 2018 ) of a 73% employment rate for released prisoners, we calculate that 44.8% of people released from prison will be employed, which we get by multiplying the 73% employment rate by the 61.4% of released prisoners who do not recidivate.

Using the baseline of 44.8%, we estimate that the 2.7% increase in the odds ratio for Employment caused by participation in ABE courses leads to a 0.66 percentage point increase in post-release Employment. This means that for every 100 students participating in prison ABE programs, about 0.66 additional people will be employed, against the counterfactual of no education program. We estimate employment increases of 0.54, 2.48, and 4.68 percentage points for secondary, vocational, and college education, respectively.

To calculate the benefit of increased Employment, we use a baseline measure of quarterly wages of $5,600 from Department of Justice data of prisoners released from federal prisons (Carson et al., 2021 ). Therefore, the 0.66 percentage point increase in Employment due to ABE participation leads to a $36.96 quarterly increase in economic gains per student educated in prison. For secondary, vocational, and college education, we estimate Employment leads to wage increases of $30.24, $138.88, and $262.08, respectively. Note that these gains are independent of the wage increases, which represent increases in income due to increases in hourly wages or hours worked, not due to an increase in Employment. The wage effect is potentially much broader since it may affect both people who found work because of a prison program and those who would have found work otherwise but experience increased wages due to the program.

The quarterly economic benefits of education via wages are $140.58 for each employed released prisoner. Starting with a baseline 44.8% employment rate, we calculate the post-release employment rate for those receiving ABE, secondary, vocational, or college education to be 45.46%, 45.34%, 47.28%, and 49.48%, respectively. We then multiply these numbers to determine the quarterly wage increase for the average education participant for each of these four types of education: $63.91, $63.74, $66.47, and $69.56. By adding these to the benefits of increased Employment, we calculate the quarterly total earnings increase for each of these four types of education: $100.87, $93.98, $205.35, and $331.64 for ABE, secondary, vocational, and college education, respectively.

However, it is important to calculate how long these benefits last. To fully determine the value of education via Employment, we must additionally estimate the current value of the increased income stream realized in the future. The estimated effects of education on wages and Employment depend on how we discount future values and the decay of positive economic effects. Tyler and Kling ( 2006 ) find that education’s positive wage and employment benefits faded mainly by the third year following release. Using this figure, while also considering standard present discounting of future revenue streams, we assume a quarterly decay rate of 9%. This means that the $100.87 economic benefit via ABE becomes $90.78 in the second quarter following release, $81.70 in the third quarter, and so on. By the end of the 3 rd year, this decay would mean the economic gain would be about $28.49. Using this framework, we calculate the present value of education via wages and Employment over 20 years. The benefit of education via wages and Employment for ABE, secondary, vocational, and college education is $993.57, $925.69, $2022.73, and $3,266.60, respectively.

ROI Calculations by Program Type

Table 6 shows the ROI estimates for each of our types of education. While each of the four types of education yields positive returns, there is significant variation in the benefits relative to the money spent on education on a per-participant basis. ABE yields an estimated 106.27% return on educational investment. This means that each dollar spent on education creates benefits yielding $2.06 in terms of cost savings associated with incarceration or increased future earnings for the prisoner. Secondary education yields a similar ROI of 124.39%. The economic return to vocational education is the highest, at 205.13%. While the ROI for college (61.15%) is low compared to all other forms of education, this is due to the high costs, not the low benefits of education. The average investment in a college participant will yield $16,908 in benefits, which is $6,441 net of costs, which is by far the highest per-student return.

The primary economic benefit of prison education is the reduction in recidivism. Given the relatively low employment rates and wages of released prisoners, the marginal impacts of education on employment measures are relatively small compared to the high costs of crime and incarceration. This means that even the most myopic view on the benefits of education (one that looks only at prison costs, ignoring the positive effects on prisoners’ future wages and the social benefits of avoiding future crimes) would still find a significant positive return to most forms of prison education systems. For all groups of programs studied here, the cost savings via reduced recidivism means that governments can reduce their incarceration-related costs by investing in prisoner education.

Results also indicate that prison education can be described as a positive externality for taxpayers and society. For each type of education program, the societal benefit via decreased recidivism is at least double that of the increased employment benefits to prisoners. Given the high societal benefit of prison education, public funding of prison education would be justified purely through cost savings.

Of course, there are numerous benefits that we are not quantifying here, such as a reduction in the costs associated with crime as well as the positive societal benefits identified with education as a whole. Studies have even found that prison education reduces instances of prison misconduct (Courtney, 2019 ). While there are likely additional benefits to prisoners of education that we cannot measure here – such as increased family cohesion and the benefit of avoiding prison for the prisoner – it is unlikely these benefits exceed those external benefits realized by society.

While many studies have estimated the effect of prison education, comparisons of education participants to non-participants are plagued by selection bias. Many of the previous meta-analyses of prison education (Wilson et al. ( 2000 ), Cecil et al. 2000 ), Bouffard et al. ( 2000 ), Chappell ( 2003 ), Aos et al. ( 2006 ), Davis et al. ( 2013 ), Bozick et al. ( 2018 )) have stressed the need for continued high-quality research to improve our understanding of how education affects post-release outcomes. While there continues to be a need for high-quality research on the subject, the recent increase in papers using quasi-experimental methods creates a need for a new meta-analysis. This paper fills that gap.

This study focuses on the efficacy of prisoner education, including ABE, secondary education, higher education, and job training, seeking to understand what effects these programs provide in improving outcomes for prisoners and, by extension, the public. Using the largest and most comprehensive set of papers used in a meta-analysis to date, we estimate the effect of prison education on various outcomes and calculate an economic return to spending on prison education. We find that prison education leads to significant decreases in recidivism, increases in Employment, and modest increases in wages. However, the impacts vary significantly across different types of education.

The breadth of our analysis provides numerous insights into public policy regarding prison education beyond those baseline results. Though we find education to be effective for each of the post-release outcomes studied, our point estimates are significantly smaller than previous meta-analyses. This is due to the increase in high-quality studies, which are more likely to find smaller effects, and more recent studies find education less effective than older studies. Because the benefits of prison education have been dropping in recent years, our estimates of the average effect should be seen as retrospective. Our main estimates are likely unrealistic expectations for future programs. However, prison education will provide significant economic and cost-saving benefits even with a more modest estimate of the causal effect.

Second, public money will be particularly well-spent on vocational education, given its high rate of return. Each dollar spent on vocational education reduces future incarceration costs by almost $2.17. Additionally, vocational education can be taken alongside academic education, as participation in one does not preclude participation in another helpful program.

Third, the financial benefits of these programs rely on prisons being able to reduce costs as rates of incarceration decrease. If smaller prison populations caused by education result in half-empty prisons with high fixed costs, it will result in higher per-prisoner costs, eating away at the economic benefits of decreased recidivism. The cost savings we estimate can only be fully realized if prisons respond to smaller populations by decreasing operating costs.

There are several limitations to our analysis. Despite the large number of papers, the dearth of papers using randomization means that the results could still be plagued by selection bias. Given the feasibility of using randomization in this setting, future research would be well-served to rely more heavily on randomized experiments. Also, our cost–benefit analysis does not wholly calculate the entire universe of costs and benefits. We do not include victimization costs or any external costs of increased crime (court or enforcement costs, negative externalities, etc.); therefore, our calculated benefits are smaller than a measure of the total societal benefits.

The costs of programs exhibit large variations. Therefore, our measure of average program costs may not reflect the true costs many programs face. Prison education programs feature high fixed costs and low marginal costs. As a result, the costs of programs appear to vary significantly in participation rates. The Windham School District, which serves most Texas prisoners, has a cost-per-participant that is a fraction of those estimates in other programs. We should expect the efficacy of education to decrease with program expansion, too. Students who are currently enrolled in education are likely to be those who stand to benefit the most. As programming expands, the marginal benefit is likely to decrease as education services are provided to students for whom the benefit is lower than average.

These limitations provide opportunities for future research and continued discussion. As education programs expand, evaluative goals should be prioritized, and randomized control trials should be conducted whenever possible. Second, in-depth analyses of the costs and benefits of prison programs are virtually non-existent. To our knowledge, only Aos et Al. ( 2001 ) have used detailed administrative data to evaluate the economic effectiveness of various prison programs. Much more research is needed in this space for policymakers to make well-informed decisions.

https://www.prisonstudies.org/highest-to-lowest/prison%20population%20rate?field%20region%20taxonomy%20tid=All

https://www.prisonpolicy.org/graphs/lifetimechance.html

Cecil et al. ( 2000 ) state that “More methodologically rigorous research is needed in this area before definitive conclusions can be drawn” while according to Bouffard et al. ( 2000 ), “more research that is well designed is needed before any definitive conclusions can be drawn about this type of intervention.”.

The total number of studies included in the meta-analysis exceeds the number of papers included, as papers that study more than one outcome (such as recidivism and employment) will be used separately.

We use the log odds ratio for our statistical analysis, and then convert these results to odds ratios, which have an intuitive interpretation.

We recreate the data and run a logit regression. Whenever papers included cross-tabulated tables, we included any possible variables. For example, Clark ( 1991 ) included recidivism data for each year. We included year dummy variables in the recreated data and as covariates in the logit regression.

*Studies marked with an asterisk were evaluated for this study

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Acknowledgements

The authors would like to thank Dr. Dan J. Smith, the Director of the Political Economy Research Institute at Middle Tennessee State University and research assistants Nicholas A. Jensen, Cruz R. García, and Shamsuddeen A. Nassarawa. We would also like to thank Miachael Van Beek and David Guenthner with the Mackinac Center for Public Policy and the helpful comments by the reviewers.

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Papers were collected for inclusion using the following method:

While not all papers from the existing meta-analyses will be included in our sample, each paper used in the following analyses was initially eligible for inclusion:

Meta-analyses:

Andrews et al. ( 1990 ), Lipsey and Wilson ( 1993 ), Wilson et al. ( 2000 ), Aos et al. ( 2006 ), Davis et al. ( 2013 ), Bozick et al. ( 2018 )

Using a set of search terms and online repositories, a set of search terms was used to identify potential papers for inclusion. Each search will consist of one of the following combinations of terms:

Academic Term AND Correctional Term

Vocational Term AND Correctional Term

Searches were conducted using each of the terms below:

Academic Terms: Education, Academic, School, Diploma, GED, Literacy, Math, Reading, Science, College

Vocational Terms: Job skills, Job training, Apprentice, Apprenticeship, Vocational education, Voc-tech, Occupational Education, Career and technical education, Workforce Development, Workforce training, Workforce preparation, School-to-work

Correctional Terms: Prison, Jail, Incarceration, Inmate, Detention Center, Corrections

Repositories: Google Scholar, Inter-university Consortium for Political and Social Research education resources information center (eric), Rutger’s Gray Literature Database, Open Access Theses and Dissertations (OATD)

We looked through the literature reviews of every paper that had been included and the list of papers that reference each of these papers (found via Google Scholar).

Throughout this process, we identified two sets of papers that were commonly missed using the procedures above (and also likely to be missed by previous meta-analyses: thesis papers and state Department of Corrections reports. To find more thesis papers, we added OATD to the list of repositories in Stage 2. To find more Department of Corrections reports, we used Google searches for stings with some variation of “prison education doc + state.”

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Stickle, B., Schuster, S.S. Are Schools in Prison Worth It? The Effects and Economic Returns of Prison Education. Am J Crim Just 48 , 1263–1294 (2023). https://doi.org/10.1007/s12103-023-09747-3

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DOI : https://doi.org/10.1007/s12103-023-09747-3

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Research Finds Prison Education Programs Reduce Recidivism

Programs help ex-offenders and save taxpayers money .

MIDLAND, Mich. — The highest quality research on prison education and workforce programs shows a positive impact on recidivism rates, earnings and employment opportunities for participants. The Mackinac Center for Public Policy released a summary of this research — the largest meta-analysis on the topic to date. The complete analysis will be published in an academic journal later this year.

Steven Sprick Schuster and Ben Stickle authored the report, working with the Political Economy Research Institute at Middle Tennessee State University. They are both professors at the university — Sprick Schuster in economics and Stickle in criminal justice administration.

They found in their review of published research that prison workforce and education programs reduce the likelihood of recidivism by 14.8%. The findings also show positive employment benefits for former offenders, including a 6.9% increase in the likelihood of employment and an extra $131 in quarterly wages.

“This research makes clear that investment in prison-based education and workforce training programs produces both safer communities and positive economic returns,” said David Guenthner, vice president for government affairs at the Mackinac Center. “We all benefit from having more ex-offenders equipped to earn their success in the workforce.”

The United States has the sixth highest prison population, with five in 1,000 people behind bars. The cost of incarcerating so many people is steep. Taxpayers spend an estimated $182 billion a year to house prisoners, pay police, and provide for courts, health care, and additional expenses. Given that many prisoners are reoffenders, some states have turned to education and workforce training in an effort to reduce recidivism and prison costs.

This meta-analysis compiled 148 results from 78 of the highest-quality research papers and studies. It used those estimates to evaluate the average effects prison educational programs have on prisoner recidivism, employment and wages. The findings are divided out by educational level, including adult basic education, high school and GED programs, vocational training and college.

Sprick Schuster and Stickle also calculated the return on investment of these programs. They found that college education programs produce the best benefit for participants, while work training provides the best return on investment from a taxpayer’s perspective. The ROI for each program was positive and that does not include many indirect benefits of lowering recidivism rates, such as fewer victims of criminal behavior and other indirect costs of crime.

Giving former offenders a better chance of success upon reentry into society should be a priority. Unfortunately, very few inmates have the opportunity to take advantage of these programs.

“Even in more forward-thinking states like Michigan, only a minuscule percentage of the inmates released back into society have access to these programs,” said Guenthner. “We will work with our research team and policymakers to lay out a path to substantially expanding these programs.”

Read the summary of the meta-analysis’ findings here .

The Mackinac Center for Public Policy is a nonprofit research and educational institute that advances the principles of free markets and limited government. Through our research and education programs, we challenge government overreach and advocate for a free-market approach to public policy that frees people to realize their potential and dreams.

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The societal benefits of postsecondary prison education

Subscribe to how we rise, alexandra gibbons and ag alexandra gibbons research intern - governance studies rashawn ray rashawn ray senior fellow - governance studies @sociologistray.

August 20, 2021

It is hard to overstate the benefits of providing postsecondary education to incarcerated students. The incarcerated population has lower average education levels than the general population, which, coupled with the stigma of a criminal record, makes it difficult for returning citizens to find jobs—especially if they are Black . Individuals who enroll in postsecondary education programs are 48% less likely to be reincarcerated than those who do not, and the odds of being employed post-release are 12% higher for individuals who participate in any type of correctional education. Estimates suggest that for every $1 spent on correctional education, $4 to $5 are saved on reincarceration costs . Additionally, individuals who complete college courses are eligible for higher-paying jobs compared to people without a college education.

Beyond fiscal benefits and inspiring stories of transformation , postsecondary prison education programs are inextricably linked to advancing racial equity, especially given inequality in K-12 education that feeds low-income Black and Latinx students into the school-to-prison pipeline . The prison population is disproportionately comprised of people from racially segregated low-income communities. Individuals returning home from prison with college credentials play an important role in encouraging family members and friends to pursue additional education.

There are significant differences in the racial makeup of the U.S. college population compared to that of Second Chance Pell , a pilot program that funds selected college-in-prison programs. As of 2018, Black students represented 13.4% of college students and 30% of Second Chance Pell students, according to surveys of Second Chance Pell programs by the Vera Institute of Justice.

That said, relative to their share of the U.S. prison population, white students are overrepresented in Second Chance Pell prison-education programs, Black students constitute roughly the same share of both populations, and Latinx students are underrepresented. Second Chance Pell programs seem to be growing slightly more diverse as time goes on—Black students made up 34% of Second Chance Pell students in 2020 , up from 30% in 2018 , and white students made up 41% of Second Chance Pell students in 2020, decreasing from 50% in 2018.

The 1994 crime bill banned incarcerated college students from accessing federal Pell Grants. Many states followed suit, banning incarcerated students from using state-level tuition aid programs. For instance, New York prohibited incarcerated students from accessing its Tuition Assistance Program (TAP) in 1995. The impact was extreme and swift: Between 1995 and 1996 , the number of postsecondary prison education programs in New York fell from 25 to four, and the number of incarcerated postsecondary students shrank from 3,445 to 256. Today, prison-education programs rely primarily on private donations, along with funding from the Second Chance Pell program, constraining the number of students that they can serve. Programs in New York had an average acceptance rate of only 33% in 2014 , and 95% of programs surveyed indicated that they could reach more students if additional financial aid was available.

Federal and state tuition-assistance programs play vital roles in supporting postsecondary prison education programs. Incarcerated people have median incomes 41% lower that other people their ages prior to being incarcerated, and are paid extremely low wages for their work in prison, much of which is deducted or used to pay for things such as medical care and personal necessities from commissary. Sixty-four percent of people in state and federal prisons are academically qualified for postsecondary prison education programs, yet as of 2014, only 9% of incarcerated individuals completed college courses while in prison.

At the end of 2020, Congress finally restored access to Pell Grants for incarcerated students, and that new provision will go into effect by July 1, 2023. Some states are also taking steps to bolster access to college in prison. Michigan granted incarcerated students access to its TAP in 2019, and New Jersey accorded access to state financial aid in 2020, joining D.C. and 17 other states without explicit barriers preventing incarcerated students from accessing state financial-aid programs. Ruth Delaney and Juan Martinez-Hill of the Vera Institute of Justice are currently conducting research on how the federal Pell Grant restoration will impact incarcerated students’ access to state financial-aid programs. Multiple states tie eligibility for their state financial-aid programs to Pell Grant eligibility. As such, Delaney and Martinez-Hill expect that once Pell restoration takes effect, the number of states without barriers precluding incarcerated students from accessing state financial aid will increase.

Yet, numerous states continue to ban incarcerated students from accessing state financial-aid programs, including states with some of the largest prison populations in the U.S., such as New York, Georgia, and Pennsylvania. In Pennsylvania, students must be of “satisfactory character” to access the Pennsylvania State Grant Program . The Pennsylvania Higher Education Assistance Agency has deemed all incarcerated individuals to be of unsatisfactory character, a racist categorization that overlooks the capacity of all people to grow.

Restoring state financial-aid access across all states to students enrolled in postsecondary prison education programs is both fiscally responsible and a moral imperative given the long history of racial injustice in the United States. The cost of doing so would be relatively small. For example, if New York gave incarcerated students access to TAP again, it would account for less than 1% of the TAP budget, and it could save the state between $22 and $27.5 million annually on reincarceration costs.

Given the dramatic payoff of postsecondary prison education, it is clear that such programs are a powerful—and cost effective—tool for rehabilitation and renewal. There are many valuable components of criminal justice reform , but we should not ignore the benefits of education and its ability to put people back on track to meaningful opportunities.

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Justice and Education Departments Announce New Research Showing Prison Education Reduces Recidivism, Saves Money, Improves Employment

Attorney General Eric Holder and Secretary of Education Arne Duncan today announced research findings showing that, on average, inmates who participated in correctional education programs had 43 percent lower odds of returning to prison than inmates who did not.  Each year approximately 700,000 individuals leave federal and state prisons; about half of them will be reincarcerated within three years.  The research, funded by the Justice Department’s Bureau of Justice Assistance, was released today by the RAND Corporation.

“These findings reinforce the need to become smarter on crime by expanding proven strategies for keeping our communities safe, and ensuring that those who have paid their debts to society have the chance to become productive citizens,” said Attorney General Holder.  “We have an opportunity and an obligation to use smart methods – and advance innovative new programs – that can improve public safety while reducing costs.  As it stands, too many individuals and communities are harmed, rather than helped, by a criminal justice system that does not serve the American people as well as it should.  This important research is part of our broader effort to change that.”

The findings, from the largest-ever analysis of correctional educational studies, indicate that prison education programs are cost effective.  According to the research, a one dollar investment in prison education translates into reducing incarceration costs by four to five dollars during the first three years after release, when those leaving prison are most likely to return.

“Correctional education programs provide incarcerated individuals with the skills and knowledge essential to their futures,” said Secretary of Education Duncan.  “Investing in these education programs helps released prisoners get back on their feet—and stay on their feet—when they return to communities across the country.”

With funding from The Second Chance Act (P.L. 110-199) of 2007, the RAND Corporation’s analysis of correctional education research found that employment after release was 13 percent higher among prisoners who participated in either academic or vocational education programs than among those who did not.  Those who participated in vocational training were 28 percent more likely to be employed after release from prison than those who did not receive such training.

The report is a collaborative effort of the Departments of Justice and Education, two of 20 federal agencies that make up the federal interagency Reentry Council.  The Reentry Council’s members are working to make communities safer by reducing recidivism and victimization; assisting those who return from prison and jail in becoming contributing members of their communities; and saving taxpayer dollars by lowering the direct and collateral costs of incarceration.  Attorney General Holder chairs the Reentry Council which he established in January 2011.

To view the research, please visit: www.bja.gov/Publications/RAND_Correctional-Education-Meta-Analysis.pdf. For more information about the federal interagency Reentry Council, please visit:  http://csgjusticecenter.org/nrrc/projects/firc/.

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The prison studies project’s mission is to awaken the broadest possible public to the ways we punish, and to reimagine justice in the united states..

In September 2008, Kaia Stern and Bruce Western launched the Prison Studies Project (PSP) at Harvard University to promote informed conversation about the challenges of mass incarceration. Born out of Harvard Law School’s Charles Hamilton Houston Institute for Race & Justice , PSP’s mission is to awaken the broadest possible public to the ways we punish, and to reimagine justice in the United States. Since its inception, PSP has been committed to raising public awareness, teaching college courses inside prison, and injecting into the public conversation a discussion of policy alternatives. Our work has focused on research, education and policy change.

Please note that the PSP website is currently under construction.

Photo by Saalik Khan, courtesy of the  Prison University Project at San Quentin

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Prisons play a key role in the U.S. economy and incarceration rates in the U.S. surpass those of any country in the world. We need to learn more about our prison system: what its origins are, whose interests it serves, and how it compares with systems of incarceration in other countries.

Based on the philosophy of  Inside-Out , a nationwide prison education program, CMU PEP offers several courses each academic year within nearby prisons. Faculty and CMU students travel together by bus to and from the prison once a week. Each course, which combines CMU students and inmates, provides full credit to CMU and incarcerated students and follows a regular CMU curriculum. CMU students should register for PEP courses through normal channels and will be asked to fill out a short questionnaire, which professors will review to determine eligibility. 

If you are interested in finding out more about the CMU Prison Education Project, or are unable to participate but are interested in volunteering as a tutor in a nearby jail or correctional institution, please contact Professor W. Goldman, Director, at [email protected]

Faculty Trained Through Inside-Out:

• Wendy Z. Goldman , Director, CMU PEP, Department of History
• Donna Harsch , Department of History
• Christopher Phillips , Department of History
• Kody Manke-Miller , Department of Psychology
• Jane McCafferty , Department of English
• Andreea Ritivoi , Head, Department of English
• Stephen Wittek , Department of English
•  Jeffrey Williams , Department of English

Fall 2024 Course Offerings

CMU PEP courses are taught on Friday afternoons at Somerset State Correctional Institution. CMU and incarcerated students will take the course together. CMU students and instructors will travel and return by chatered bus. The bus leaves at 12:30 p.m. returns around 7 p.m.

Registration opens Monday, April 15 .

85-201: Psychology and Society

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Psychology and Society focuses on how knowledge of psychology can improve our lives and society, in domains from health to relationships to education to intergroup interactions and more. The course will be largely discussion based, with readings, reading quizzes, and brief written reflections. Students will use the things they learn about psychology to suggest ways to improve problems that they care about.

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Instructor: Stephen Wittek

In the closing decades of the sixteenth century, cultural producers in early modern London began to develop a new commercial venture called ‘playing’: a business that offered ordinary people a few hours of dramatic entertainment for the price of one penny. More than four hundred years later, the drama of that period now ranks among the most esteemed texts in all English literature, and the name ‘Shakespeare’ has become a byword for literary genius. This course will offer an overview of Shakespeare’s tragedies and histories, what they meant to audiences then, and how they influence us today.

Student Experiences

"Being a part of [this] course [...] was one of the most unique and rewarding experiences I’ve had at CMU, as I was able to engage in profound discussions with people I do not normally interact with on a daily basis — students who were ostensibly so different from myself but filled with compassion and expressed just as much enthusiasm, if not more, for psychology as I did. I found this course to be irreplaceable by any other traditional college class, providing a distraction-free learning experience where we could all come together and dive deep into the material [and] openly share our thoughts with one another [...] In short, this experience both challenged my naive assumptions surrounding people who are incarcerated and also helped shape how I think about psychology and education in general." — Amor, Junior, Triple Major in Statistics, Psychology and Decision Science

"I cannot begin to express how much [this course] was appreciated. I always looked forward to Fridays, not only because I was getting off the housing unit and going to school, but mainly because the professor and the CMU students treated me and the other inmates like real people."  — Brandon, SCI Somerset 

"This program gave me an amazing opportunity to expose myself to people with different life experiences than mine. It's not every day you get the chance to communicate across difference in this way, especially in a setting where the goal is to learn with each other. It's been an inclusive and inspiring learning experience that I'm grateful was a part of my time here."  — Camille, Junior, Double Major, Psychology and Decision Science

"The CMU Prison Education Project was one of the most influential experiences I have ever had. I have never been in a class with more engaging, perceptive and dedicated students, and this program entirely changed my relationship with education and learning. The CMU Prison Education Project is truly a once in a lifetime opportunity and I could not recommend this course more." — Rowan, Junior, School of Drama

"All in all, I have thoroughly enjoyed the entire experience of the program.  It offered an enclave of humanity and higher education within an environment that is often bereft of both. I was challenged by new perspectives, gained useful knowledge of a fascinating topic and developed an interest in further learning. The concepts and ideas sparked by the lectures, readings, discussions and in-class interactions will continue to motivate me toward positive action and success." — Jacob, SCI Somerset

"Through the CMU Prison Education Program, I have been able to explore different perspectives that I wouldn’t otherwise find on campus. I’ve really enjoyed being able to listen and have deep conversations with people whose life experiences are vastly different from mine."  — Jennifer, Senior, Major, Computer Science

"Being a part of the [CMU Prison Education Project] in my last semester of college is a memory that will stay with me for a very long time. It’s such a unique opportunity for college students, and it has heavily changed my perception on prisons and prison systems. The inside students I spent time with were some of the most passionate students I’ve ever met, and I loved that we could learn so much from each other just by being in each other’s presence."   — Catherine, Senior, Major, Design

"The experience of watching equal numbers of CMU and Somerset Prison students get certificates for completing courses taught this semester was deeply gratifying. Our students were transformed and said so. The prison students were profoundly grateful and said so. The professors were profoundly energized and said so. I've been in higher education for 35 years, and I've never seen anything like it."  — Richard Scheines, Bess Family Dean, Dietrich College of Humanities and Social Sciences

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Students’ Sense of Belonging Matters: Evidence from Three Studies

On Thursday, February 16, we hosted Dr. Maithreyi Gopalan to discuss her latest research on how students’ sense of belonging matters.

• Evidence has shown that in certain contexts, a student’s sense of belonging improves academic outcomes, increases continuing enrollment, and is protective for mental health. In some of the studies presented, these correlations were still present beyond the time frame of the analysis, suggesting that belonging might have a longitudinal effect.
• Providing a more adaptive interpretation of challenge seemed to help students in a belonging intervention make alternative and more adaptive attributions for their struggles, forestalling a potential negative impact on their sense of belonging.

Professor Gopalan began her talk by discussing how the need for “a sense of belonging” has been identified as a universal and fundamental human motivation in the field of psychology. John Bowlby, one of the first to conduct formal scientific research on belonging, examined the effects on children who had been separated from their parents during WWII (Baumeister & Leary, 1995). From his pioneering work, Bowlby and colleagues proposed that humans are driven to form lasting and meaningful interpersonal relationships, and the inability to meet this need results in loneliness and mental distress. Educational psychologists adapted the concept of belonging to indicate how students’ sense of fit with themselves and with their academic context can affect how they perceive whether they can thrive within it (Eccles & Midgley, 1989; Eccles & Roeser, 2011).

After providing this brief overview of what belonging means more broadly, Dr. Gopalan introduced the concept of “belonging uncertainty” pioneered by social psychologists Geoffrey Cohen and Gregory Walton at Stanford University (Walton & Cohen, 2007) to describe the uncertainty students might feel about their belonging when entering a new social and academic situation , which is most pronounced during times of transition (e.g., entering college). Research has shown that belonging uncertainty affects how students make sense of daily adversities, often interpreting negative events as evidence for why they do not belong. Belonging uncertainty may result in disengagement and poor academic outcomes. In contrast, a sense of belonging is associated with academic achievement, persistence in the course, major, and college (Walton & Cohen, 20011, Yeager & Walton, 2011). It is the concept of belonging uncertainty that is the focus of Dr. Gopalan’s presentation, with emphasis on the findings from the following key research questions:

• How do students’ sense of belonging in the first year correlate with academic persistence and outcomes at a national level?
• Can belonging interventions during the first semester of college lead to increased persistence and academic achievement in a diverse educational setting?
• How does a student’s sense of belonging amidst the COVID-19 pandemic correlate with mental health?

Study 1: College Students’ Sense of Belonging: A National Perspective (Gopalan & Brady, 2019)

Most research examining college students’ sense of belonging has come from studies looking at one or a few single four-year institutions. To examine how belonging differs across student identities and institutions, Professor Gopalan and colleagues looked at the responses from the only nationally representative survey of college students to date that had measured belonging. The Beginning Postsecondary Students Longitudinal Study (BPS) (Dudley et al ., 2020) sampled first-time beginning college students from 4070 eligible two- and four-year institutions (N= 23, 750 students), surveyed during their first year and subsequently two years later.

Professor Gopalan examined average measurements of belonging across institution type and student characteristics (Gopalan & Brady, 2019) and associations between belonging measurements and measurements of academic achievement, including GPA and persistence (continued enrollment), self-reported mental health, and self-reported use of campus services. The results, Dr. Gopalan explained, were striking: underrepresented racial and ethnic minority students (URMs) and first-generation/low-income students (FGLIs) reported a lower sense of belonging in four-year colleges than their non-URM and non-FGLI counterparts. 1 Importantly, they also found that having a greater sense of belonging is associated with higher academic performance, persistence, and is protective for mental health in year three of students’ undergraduate trajectory, suggesting that belonging might have a longitudinal effect (Gopalan & Brady, 2019). These findings were consistent with previous results from smaller studies involving single institutions. Sense of belonging is important not just in specific institutions but nationally, and social identity and context matter . One practical and policy-driven takeaway from this study is that only one national data set currently measures students’ sense of belonging using a single item. More robust measurements and large data sets might reveal additional insights into the importance of belonging for students’ educational experiences.

1 At two-year colleges, first-year belonging is not associated with persistence, engagement, or mental health. This suggests that belonging may function differently in two-year settings. More work is ongoing to try to understand the context that might be driving the difference. (Deil-Amen, 2011).

Study 2: A customized belonging intervention improves retention of socially disadvantaged students at a broad-access university (Murphy et al ., 2020)

Professor Gopalan and colleagues wanted to understand how to adapt existing belonging interventions to different educational contexts and dig deeper into underlying psychological processes underpinning belonging uncertainty. Because previous social-belonging interventions were conducted in well-resourced private or public institutions, Professor Gopalan was interested in examining whether the positive effects of belonging interventions could be extended to a broader-access context (context matters as not all extensions of belonging interventions have been shown to reproduce persistent changes in enrollment and academic outcomes). For this purpose, the traditional belonging interventions were customized for a four-year, Hispanic-serving public university with an 85% commuter enrollment using focus groups and surveys. Based on prior research, belonging interventions provide an adaptive lay theory for why students encounter challenges during transition times (Yeager et al ., 2016). Students, particularly those with little knowledge of how college works or those who have experienced discrimination, or are aware of negative stereotypes about their social group, may make global interpretations of why college can be challenging and may even associate challenges as evidence that they and students like them don’t belong. With belonging interventions, the lay theory provided to students aims to frame the experience of challenge in more adaptive ways—challenge and adversity are typical experiences, particularly during transitional moments, and should be expected; adapting academically and socially takes time—students will be more likely to persist, seek out campus resources and develop social relationships.

• They acknowledge that challenges are expected during transitions and that these are varied.
• They communicate to students that most students, including students from non-minority groups, experience similar challenges and feelings about them.
• They communicate that belonging is a process that takes time and tends to increase over time
• They use student examples of challenges and resolutions.

The Intervention

All students in the first-year writing class were randomly assigned to either the belonging group or an active control group. The intervention was provided to first-year students in their writing class and consisted of a reading and writing assignment about social and academic belonging. The control group was given the same assignment but with a different topic, study skills. In the intervention group, students read several stories from a racially diverse set of upper-level students who reflected on the challenges of making friends and adjusting to a new academic context. The hypothetical students reflected on the strategies they used, the resources they accessed, and how the challenge dissipated over time. After the reading exercise, the students in the intervention group were instructed to write about how the readings echoed their own first-year experiences. Then, they were asked to write a letter to future students who might question their belonging during their transition to college. Research has shown that written reflections help students internalize the main messages of the belonging intervention (Yeager & Walton, 2011).

Similar to previously published belonging interventions, results in persistence and academic achievement were significant for minoritized groups in the belonging cohort:

• Persistence. Compared to the control group, continuous enrollment for URM & FGLI students increased by 10% one year after and 9% two years after the intervention.
• Performance. The non-cumulative GPA from the URM & FGLI students increased by 0.19 points the semester immediately following the intervention and by 0.11 over the next two years compared to students in the control group.

Immediately following the intervention, a selected sub-sample of students in both conditions was invited to take a daily diary survey for nine consecutive days. The daily diary survey assessed students’ daily positive and negative academic and social experiences (students were asked to report and describe three negative and three positive events that they faced daily and to rate how positive and negative the events were), as well as their daily sense of social and academic belonging. The daily-diary assignment revealed another interesting finding: the intervention did not change the overall perception of negative events. URM & FGLI students in both groups had a statistically similar daily-adversity index and reported the same number of daily adverse events on average. However, there was no connection between the adversity index and sense of belonging for students in the belonging cohort. In contrast, students in the control group evidenced a negative correlation between daily adversities and belonging: “the greater adversity disadvantaged students experienced on a day, the lower their sense of social and academic fit” (Murphy et al ., 2020).

Providing a more adaptive interpretation of challenge seemed to help students in the belonging condition make alternative and more adaptive attributions for their struggles that did not connect to their sense of belonging. A follow-up survey one year after the intervention showed that minoritized students in the belonging intervention continued to report a higher sense of belonging in comparison to their counterparts in the control group.

Study 3: College Student’s Sense of Belonging and Mental Health Amidst the COVID-19 Pandemic (Gopalan et al ., 2022)

Dr. Gopalan presented the third study, which turned out to provide a unique opportunity to assess whether sense of belonging had predictive effects on mental health. In the fall of 2019, researchers sent a survey to students at a large, multicampus Northeastern public university called the College Relationship and Experience survey (CORE), which included two questions about belonging, among other items. In the Spring of 2020, after students were sent home due to the COVID-19 pandemic, a variation of the same survey was sent to students who had taken the CORE survey. After controlling for pre-COVID depression and anxiety, Dr. Gopolan and colleagues found that students who reported a higher sense of belonging in the fall of 2019 had lower rates of depression and anxiety midst-COVID pandemic , with the effects on depression more strongly predictive than those for anxiety. The correlation between a lower sense of belonging and higher rates of depression and anxiety was also found to be strongest for first-year students, who had little time during their first year to build community and adjust to college before the pandemic hit.

Dr. Gopalan concluded with some practical advice for instructors: “Stop telling students they belong, show them instead that they belong,” citing a recent op-ed from Greg Walton . We do this by modeling the idea that belonging is a process that takes time and by communicating to students that they are not alone , which can be done through sharing our own experiences with belonging, and by allowing students space to hear the experiences of their peers and learn from one another.

• Classroom Practices Library which includes Overview: Effective Social Belonging Messages are more.
• The Project for Education Research That Scales (PERTS) : a free belonging intervention for four-year colleges and universities.
• Research library on belonging
• Article on Structures for Belonging: A Synthesis of Research on Belonging-Supportive Learning Environments
• “Stop telling students ‘You Belong!’”
• Everyone is talking about belonging: What does it really mean?
• Post-secondary
• Academic Belonging : introduction to the concept and practices that support it.
• Flipping Failure : a campus-wide initiative to help students feel less alone by hearing stories about how their peers coped with academic challenges

Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117 (3), 497–529. https://doi.org/10.1037/0033-2909.117.3.497

Deil-Amen, R. (2011). Socio-academic integrative moments: Rethinking academic and social integration among two-year college students in career-related programs. The Journal of Higher Education , 82(1), 54-91. https://doi.org/10.1080/00221546.2011.11779085  

Dudley, K., Caperton, S.A., and Smith Ritchie, N. (2020). 2012 Beginning Postsecondary Students Longitudinal Study (BPS:12) Student Records Collection Research Data File Documentation (NCES 2021-524). U.S. Department of Education. Washington, DC: National Center for Education Statistics. Retrieved 2/27/2023 from https://nces.ed.gov/pubsearch/pubsinfo.asp?pubid-2021524

Eccles, J. S., & Midgley, C. (1989). Stage/Environment Fit: Developmentally Appropriate Classrooms for Early Adolescence. In R. E. Ames, & Ames, C. (Eds.), Research on Motivation in Education , 3, 139-186. New York: Academic Press.

Eccles, J. S., & Roeser, R. W. (2011). Schools as developmental contexts during adolescence. Journal of Research on Adolescence, 21 (1), 225–241. https://doi.org/10.1111/j.1532-7795.2010.00725.x

Gopalan, M., & Brady, S. T. (2020). College Students’ Sense of Belonging: A National Perspective. Educational Researcher , 49(2), 134–137. https://doi.org/10.3102/0013189X19897622

Gopalan, M., Linden-Carmichael, A. Lanza, S. (2022). College Students’ Sense of Belonging and Mental Health Amidst the COVID-19 Pandemic, Journal of Adolescent Health , 70(2), 228-233. https://doi.org/10.1016/j.jadohealth.2021.10.010

Murphy, M.C., Gopalan, M., Carter, E. R., Emerson, K. T. U., Bottoms, B. L., and Walton, G.M., (2020). A customized belonging intervention improves retention of socially disadvantaged students at a broad-access university Science Advances, 6(29). DOI: 10.1126/sciadv.aba4677

Walton, & Cohen. (2007). A question of belonging: Race, social fit, and achievement. Journal of Personality and Social Psychology, 92(1), 82. https://doi.org/10.1037/0022-3514.92.1.82

Walton, G.M., & Cohen, G.L. (2011). A Brief Social-Belonging Intervention Improves Academic and Health Outcomes of Minority Students. Science,  331(6023), 1447-1451.  DOI: 10.1126/science.1198364

Yeager, D. S., & Walton, G. M. (2011). Social-Psychological Interventions in Education They’re Not Magic. Review of Educational Research, 81(2), 267–301. http://doi.org/10.3102/0034654311405999

Yeager, D.S., Walton G.M., Brady, S.T., Dweck, C.S.,(2016). Teaching a lay theory before college narrows achievement gaps at scale, Psychological and Cognitive Sciences , 113(24), E3341-E3348. https://doi.org/10.1073/pnas.1524360113

belonging inclusive classroom student engagement wellbeing

Whitney Hough received the 2024-25 U.S. Institute of Peace fellowship

Whitney hough received the 2024-25 u.s. institute of peace fellowship for her doctoral research.

Our doctoral student Whitney Hough received the U.S. Institute of Peace (USIP) and the Minerva Research Initiative Peace Scholar Fellowship for pursuing her doctoral research. 

Whitney, a third-year Ph.D. student in the Comparative and International Education Program, is deeply passionate about her research. Her focus lies at the intersection of education, conflict, development, and peacebuilding. She is particularly intrigued by the challenges of providinghigh-quality secondary education in emergencies, the agency of teachers in crisis and conflict-affected contexts, and the transformative role of education in protracted conflict. With 15 years of progressive experience in the international education and nonprofit sectors, including a recent role as the Deputy Project Director for Fulbright Teacher Exchanges at IREX, a global international education development nonprofit, Whitney brings a wealth of practical knowledge to her academic pursuits. She holds a master’s degree in Conflict, Security and Development from the University of Bradford UK, and a Bachelor’s in Psychology and Cross Cultural Studies from Carleton College.

The fellowship that Whitney has been awarded is a testament to her academic prowess and the importance of her research. The 2024-25 USIP-Minerva Peace and Security Scholar Fellowship, funded by the US Institute of Peace and the Minerva Research Initiative, is a highly prestigious award. It provides full-time support for dissertation research from September 1, 2024, to June 30, 2025. The Fellowship also includes opportunities for academic engagement, such as attendance at the annual US Institute of Peace Workshop, regular dissertation progress reports, contributions to the USIP Peace Scholar newsletter, and participation in Peace Scholar roundtable discussions.

Whitney Hough, third-year Ph.D. student in CIE program

The project is entitled “Teachers as Transformative Agents During Protracted Conflict: A Case Study of Cameroon” . It is a qualitative case study that explores the role of teachers in conflict and peacebuilding across six secondary schools in the Anglophone regions of Northwest and Southwest Cameroon. The study aims to analyze what teachers perceive as their responsibilities in fostering peace in conflict-affected contexts, the opportunity and risk factors they associate with adopting those responsibilities, and how they use agency to adopt, adapt, and/or resist peacebuilding efforts.

When asked about how her experience at TC contributed to her research,  Whitney told us: “ I've appreciated the opportunity at TC to be involved in Dr. Mendenhall's UNHCR Typology of Teachers of Persons of Concern Project, which involved fieldwork in Chad and Uganda, along with Dr. Mendenhall's BRICE Teacher and Student Well-Being project, and Dr. Garnett Russell's Newcomer and Refugee Youth Project. Those initiatives helped me learn how best to approach fieldwork, study design, and data analysis.”

Congratulations, Whitney, on this fantastic achievement! We are excited to see the fruits of this work in the future!  

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• University of Michigan study engages parents in protecting young children from unintentional shootings

Q&A with Alison Miller

Professor, health behavior and health education.

May 1, 2024

After teens, young children from birth to 5 years old  are the largest age group impacted by unintentional shootings and have the highest number of firearm fatalities in the United States. And an estimated 30 million US children lived in households with firearms . 

Research is limited on firearm safety perspectives and practices of parents with young children, and a team of researchers from the University of Michigan are working together to better tailor firearm safety approaches and communications to meet the needs of parents.

Called the Supporting All Families through Education and Responsible Management and Storage (SAFE ARMS) study, the three-year CDC-funded research project focuses on understanding how parents think about firearm safety for their young children.

Alison Miller , professor of Health Behavior and Health Education at the University of Michigan School of Public Health, and Hsing-Fang Hsieh , research assistant professor at the university’s Institute for Firearm Injury Prevention and Michigan Public Health alumna , serve as co-principal investigators of the project.

Here, Miller discusses the project and what the firearm injury prevention researchers hope to learn from their research. 

Why is it important to do this study? What do you hope to learn?

Despite the urgent need to address this issue, there has been limited research to understand firearm safety practices among parents with children aged 0 to 5 years. 

That means that although parents play an important role in keeping their children safe, we don’t know how best to engage parents around these issues. Messaging comes mostly from experts.

So, understanding how parents think about firearm safety for their young children is an important first step in engaging parents in preventing firearm injury. 

Why is it important to engage parents to talk about firearm safety for their young children? 

Parents’ views of the risk for firearm injury may differ from experts’ views, creating challenges in delivering effective firearm injury prevention messaging and promoting firearm safety practices. 

For example, parents who own firearms for protection may prioritize easy access to firearms as most important for safety, while experts may prioritize secure storage as most important for safety. There are data to show that children know where firearms are stored, even when parents think they are hidden. 

We want to identify gaps or misalignments in parents’ views compared to experts’ views in order to craft more effective messaging and enhance safety for young children. The SAFE ARMS study seeks to do just that.

What are the key milestones for the SAFE ARMS study?

The three-year project involves three phases with specific milestones to be achieved:

• Phase 1 (Survey, Focus Groups and Interviews): Use a combination of research methods to assess parents’ understanding of firearm safety and injury prevention related to their firearm safety practices.
• Phase 2 (Intervention Development): Translate Phase 1 results to inform an intervention approach designed to increase firearm safety practices among families with young children.
• Phase 3 (Pilot Testing): Pilot-test the firearm safety intervention using parent-empowerment techniques and peer educators to engage parents of young children. 

You are a developmental psychologist by training. How do you incorporate that aspect of your work into this firearm injury prevention research?

As a developmental psychologist who studies and works with young children and their families, I know how important both child factors and parent expectations can be in shaping family behaviors. 

For example, child factors related to age and development, such as motor skills and physical growth, can enable a young child to climb up high and get places quickly—often more quickly than parents realize. Fine motor skills can allow a young child to grab and manipulate small objects. Unfortunately, in the case of firearms these natural child capacities can have disastrous results if a child gains access to an unlocked firearm—it has been shown that preschoolers have enough finger strength to pull most handgun triggers . 

Furthermore, we know young children are curious, often persistent, are sometimes not able to control their impulsive behavior, and like to model the behaviors of adults and others. So, if a child sees a firearm they may be eager to touch it and imitate what they have seen others do (including parents, superheroes, cartoons, or other characters in the media).    

Parents of young children are often surprised at their child’s rate of development during the first years of life—indeed, “babyproofing” is the idea of encouraging families to prevent injuries by changing the home environment early (e.g., putting a gate on the stairs when the child is an infant, before the child starts walking). Parents also often marvel at how much their children learn just by watching, even when we don’t think they are watching. For example, children often know where presents or cookies are “hidden” in their households, so if a firearm is stored in a typical “hiding place” where a parent believes it to be hidden, or up high, the child may find it more easily and quickly than a parent may think. 

Unfortunately, children are more likely to be injured when firearms are in the home, especially if they are not stored securely , which is part of the reasoning behind the new Child Access Prevention (CAP) law in Michigan, which requires locked firearm storage when children are present. Policies like these are important as they are associated with fewer child firearm injuries , but we need efforts at multiple levels, including family-focused supports, to keep children safe from unintentional firearm injuries. 

It is therefore critical for researchers to engage parents to understand their perspectives and motivations for gun ownership —often the reason that parents own firearms is to keep their families safe. It is also critical for parents who choose to have firearms in the home to be aware of child factors and early developmental influences so that they can take preventive action for safe firearm storage, just like babyproofing, to keep their young children safe. 

• Department of Health Behavior and Health Education
• SAFE ARMS research page
• Public Health IDEAS for Preventing Firearm Injuries

Contact Destiny Cook Senior Public Relations Specialist University of Michigan School of Public Health [email protected] 734-647-8650

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Summer learning loss: What we know and what we’re learning

Concerns about students losing ground academically during summer break go back at least a century, with early evidence suggesting that summer contributed to large disparities in students’ outcomes. This narrative spurred expansion of a variety of summer programs and interventions aimed at stemming summer learning loss.

However, in the last five years, there has been a spirited debate about two long-standing questions about students’ summers: 1) the degree to which test scores actually drop during the summer and 2) the degree to which summer break contributes to educational inequities. A new layer to this conversation is the response to the learning disruptions caused by the COVID-19 pandemic. School leaders and policymakers have used the summer break as a potential time for academic recovery. Summer programs have emerged as one of the most popular recovery strategies offered by school districts, with an estimated $5.8 billion of ESSER funds expected to be spent on summer programs by September 2024.

With more focus on the impact of summer on students’ learning and the potential to extend the school year, it is essential for educators, policymakers, and families to have an up-to-date understanding of the impact of summer breaks on students’ learning patterns. In this post, we aim to highlight what is known about summer learning loss by quickly summarizing recent research and posing some questions that remain unanswered about the role of summers on students’ learning.

Students’ test scores flatten or drop during the summer

While our initial understanding of summer learning loss dates back to studies conducted in the 70s and 80s , a recent collection of studies in the last six years provides a fresh look at students’ learning across summers using four modern assessments ( ECLS-K direct cognitive tests , MAP® Growth™, Star, and i-Ready) with large national (though not typically nationally representative) samples. See “School’s out: The role of summers in understanding achievement disparities,” “When does inequality grow? School, summer, and achievement gaps,” “Evidence of ‘summer learning loss’ on the i-Ready diagnostic assessment,” “Findings on summer learning loss often fail to replicate, even in recent data,” and “Inequality in reading and math skills forms mainly before kindergarten: A replication, and partial correction, of ‘Are schools the great equalizer?’”

Figure 1 compares the test score patterns across four different studies. Three important patterns stand out:

• On average, test scores flatten or drop during the summer , with larger drops typically in math than reading.
• Studies using test scores from ECLS-K:2011 show that student learning slows down but does not drop over the summers after kindergarten and first grade. However, research using interim and diagnostic assessments ( MAP Growth , Star, and i-Ready ) has found far larger summer drops across a range of grade levels.
• Given the sizable differences in the magnitude of test score drops across tests, it remains uncertain whether summer slide should be considered a trivial issue or a serious educational challenge.

Figure 1. Comparison of summer slide estimates across datasets

Note: All estimates are reported as the total average summer test score change in standard deviation (SD) units relative to the prior spring test score. Whenever possible, we report the estimate that adjusted scores for time in school prior/after testing in the fall and spring. Sources: Author calculations based on data reported in ECLS-K:20210-11 , MAP Growth , i-Ready , and Star .  

Who is most likely to show summer learning loss.

While all three diagnostic assessments show some degree of summer slide in grades 3–8 on average, the research community lacks consensus about whether summers disproportionately impact certain students. Paul von Hippel and colleagues have pointed out that whether and how much summers contribute to educational inequalities (across students of different income levels, races, ethnicities, and genders) depends on the test used to study students’ learning patterns. Nonetheless, we can present a few key patterns from this line of research:

• Learning rates are more variable during the summer than during the school year. See “School’s out: The role of summers in understanding achievement disparities,”   “When does inequality grow? School, summer, and achievement gaps,”  and  “Inequality in reading and math skills forms mainly before kindergarten: A replication, and partial correction, of ‘Are schools the great equalizer?’”
• Gaps between students attending low- and high-poverty schools do not consistently widen during the summer. See “Is summer learning loss real, and does it widen test score gaps by family income?”  and  “Is summer learning loss real?”
• Test score differences between Black and white students hold steady or narrow during the summer. See “Do test score gaps grow before, during, or between the school years? Measurement artifacts and what we know in spite of them”  and  “When does inequality grow? School, summer, and achievement gaps,” though results can be sensitive to the metric and test used. See also  “Black-white summer learning gaps: Interpreting the variability of estimates across representations” and “Findings on summer learning loss often fail to replicate, even in recent data.”
• The field cannot really explain why differences in students’ summer learning occur. See “Rethinking summer slide: The more you gain, the more you lose”  and  “Inequality in reading and math skills forms mainly before kindergarten: A replication, and partial correction, of ‘Are schools the great equalizer?’”

Planning effective summer programming

It is clear across recent studies that summer is a particularly variable time for students. Summer break is also increasingly a time in which districts are offering a range of academic offerings.

During summer 2022, an estimated 90% of school districts offered summer programs with an academic focus. However, evidence on the effectiveness of academic summer programs during and after the COVID-19 pandemic is limited. One study of eight summer programs in summer 2022 found a small positive impact on math test scores (0.03 SD), but not on reading. The improvements in math were largely driven by elementary students compared to middle schoolers. However, the effectiveness of these programs remained consistent across student groups, including race/ethnicity, poverty, and English learner status.

It is crucial to recognize the challenges associated with scaling up summer programs. In the districts studied, only 13% of students participated in the summer programs , which only lasted for an average of three to four weeks. Prior research indicates that for summer programs to yield measurable academic benefits, they should run at least five weeks with at least three hours of instruction a day. Additionally, getting students to regularly attend summer programs remains a significant hurdle. To address this issue, districts should actively recruit families to participate and offer a mix of academic instruction and engaging extracurricular activities. By adopting these strategies, districts can maximize the effectiveness of their summer programs and better support student learning during the break.

If you’re interested in learning more about effective summer programs, we encourage you to read the following:

• “Effective summer programming: What educators and policymakers should know”
• “Investing in successful summer programs: A review of evidence under the Every Student Succeeds Act”
• “Analysis: Summer learning is more popular than ever. How to make sure your district’s program is effective”
• “The impact of summer learning programs on low-income children’s mathematics achievement: A meta-analysis”
• “The effects of summer reading on low-income children’s literacy achievement from kindergarten to grade 8: A meta-analysis of classroom and home interventions”

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Study Shows How Higher Education Supports Asian American, Native Hawaiian, and Pacific Islander Students Through Culturally Relevant Courses, Programs, and Research

Analysis of minority-serving institutions on the East and West Coasts demonstrates layered processes to build students’ capacities

The model minority myth paints a picture of Asian Americans as a monolithic group with unparalleled success in academics. A new NYU study unpacks this myth, exploring the needs of Asian American, Native Hawaiian, and Pacific Islander students and how higher education institutions support these populations.

In 2007, Congress established a federal designation for higher education institutions that enroll at least 10 percent of undergraduate Asian American, Native Hawaiian, and Pacific Islander (AA&NHPI) students, and who enroll a significant proportion of students from low socioeconomic backgrounds. This designation as an Asian American and Native American Pacific Islander Serving Institution (AANAPISI) was among one of the newest categories of minority-serving institutions that receive federal funding to advance educational equity and support for ethnic and racial minorities.

In a two-site case study, Mike Hoa Nguyen , assistant professor of education at NYU Steinhardt, collected data from interviews, internal and public university documents, and observations of activities, courses, and meetings to determine the process in which AANAPISI programs expand students’ capacities through culturally relevant coursework, mentorship, research, and civic engagement. His findings are published in The Review of Higher Education .

“AANAPISIs demonstrate a federal commitment to supporting the unique educational needs of AA&NHPI students, which are too often obscured by the model minority myth,” said Nguyen. “This myth dangerously asserts that Asian American students, and Native Hawaiian and Pacific Islander students by association, are universally successful and unparalleled in their academic achievements. AANAPISIs play a major role in addressing this problem, and in doing so, provide critical resources to uplift the students they serve. This study documents the process in which these colleges and universities engage in this important work.”

Nguyen's study centered on a large, public community college on the West Coast and a large, urban, regional public university on the East Coast. Nguyen’s findings related to the experiences of students in these programs.

He uncovered a five-tiered process that the two institutions use to build opportunities for learning, practice, and engagement:

AA&NHPI Focused Coursework At both institutions, courses focused on these populations are offered through the institutions’ Asian American Studies programs, where students are exposed to concepts connected to their racial and ethnic identities. One student shared her experience with a course, Asian Women in the United States, “Through my experience with that class I learned…for the first time, issues that affected my community. Specifically, me as an Asian American woman, specifically Vietnamese American…”

Teaching and Mentoring Students who had previously taken AA&NHPI coursework provided tutoring and mentoring to support new students with classwork, programs, books, and scholarship applications.  According to one mentor, “Cambodian Americans fall through the cracks, we’re just not in higher ed…It’s not a supportive space for us…[the AANAPISI faculty] understand…from their own community work, from being on campus, and [from] teaching for so long that…when they find students who fit these demographics it makes sense for them to mentor them.”

Advanced AA&NHPI Focused Coursework After serving as mentors, students often take more advanced courses focused on theoretical, historical, and contemporary issues regarding the AA&NHPI experience to continue their academics while gaining tools to make larger contributions toward their communities. 

Academic and Research Development Students who complete advanced coursework are provided opportunities to engage in academic projects and research with faculty and staff, presenting research at conferences or publishing in peer-reviewed journals. 

Professional and Community Experience The final step in the process offers opportunities for students to engage in community-based projects, internships, and employment with partner organizations, government offices, or other schools. A student shared that his research experience led to the creation of a Vietnamese American organizing and training program. “[Researchers] found out that Vietnamese Americans in [the neighborhood] don't participate in civics or politics…they basically feel disenfranchised, like their vote doesn’t matter…So, the research showed that there needs to be an organization to help push and provide opportunities to talk about politics in a Vietnamese American progressive context…”

“AANAPISIs are the backbone for AA&NHPI students in higher education. These institutions account for six percent of all colleges and universities, yet enroll over 40 percent of all AA&NHPI undergraduates,” said Nguyen. “This study offers new understandings of the critical role that AANAPISIs play to expand educational opportunity and enrich learning experiences—which can be adopted beyond AANAPISIs and for other students—as well as inform the work of policymakers as they seek new solutions to refine and regulate the administration of minority-serving institutions.”

Funding for this study was provided by the UCLA Institute of American Cultures and the UCLA Asian American Studies Center. 

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Prominent Gaza Doctor Dies in Israeli Prison

FILE PHOTO: Palestinians inspect damages at Al Shifa Hospital after Israeli forces withdrew from the Hospital and the area around it following a two-week operation, amid the ongoing conflict between Israel and Hamas, in Gaza City April 1, 2024. REUTERS/Dawoud Abu Alkas/File Photo

By Nidal al-Mughrabi and Ali Sawafta

CAIRO/RAMALLAH, West Bank (Reuters) -A senior Palestinian doctor died in an Israeli prison after more than four months of detention, two Palestinian prisoner associations said on Thursday, blaming Israel for his death.

The associations said in a joint statement that Adnan Al-Bursh, head of orthopedics at Al Shifa Hospital, Gaza's largest medical facility, had been detained by Israeli forces while temporarily working at Al-Awada Hospital in north Gaza.

They called his death an "assassination" and said his body remained in Israeli custody.

War in Israel and Gaza

The Israeli prison service issued a statement on April 19, saying that a prisoner detained for national security reasons had died in Ofer prison but giving no detail on the cause of death. A prison service spokesperson confirmed that the statement referred to Bursch, and said the incident was being investigated.

Medical groups, including the World Health Organization, have repeatedly called for a halt to attacks on Gaza healthcare workers, with more than 200 killed so far in the Gaza conflict, according to an estimate from Insecurity Insight, a research group that collects and analyses data on attacks on aid workers around the world.

The Palestinian health ministry said in a statement that Bursh’s death raised to 496 the number of medical sector workers who had been killed by Israel since Oct 7. It added that 1,500 others had been wounded while 309 had been arrested.

Francesca Albanese, the U.N. Special Rapporteur on the human rights situation in the West Bank and Gaza, said in comments on X that she was alarmed by Bursh's death in Israeli detention and urged the diplomatic community to take concrete measures to protect Palestinians.

"How many more lives will have to be taken before UN Member States, especially those demonstrating genuine concern for human rights globally, act to protect the Palestinians?" she said.

Israel accuses Hamas of using hospitals for military purposes and says its operations against them have been justified by the presence of fighters. Hamas and medical staff deny the allegations.

Earlier on Thursday, the Israeli authorities released 64 Palestinians they had detained during their military offensive in Gaza via the Israeli-controlled Kerem Shalom crossing, the Palestinian borders and crossings agency said.

One of them was the body of another man who had died in detention, the prisoners' associations said.

Another freed detainee arrived in critical condition and was moved into hospital upon arrival, the crossings agency added.

Dozens of Palestinians who had been freed by Israel in past months including some staff of a U.N. agency have reported ill-treatment during detention, including torture and deprivation of food and sleep.

The two new deaths bring the toll of Gazans who died in Israeli custody to at least 18 since the start of the war, the prisoners associations said, urging Israeli authorities to disclose the number, location and fate of detainees from Gaza.

The U.N. Palestinian Refugee Agency has documented the release of 1,506 people detained by the Israeli authorities through the Kerem Shalom crossing as of April 4 and said the transfer of detainees regularly holds up aid. The 1,506 included 43 children and 84 women, it said.

Israel's military operation in Gaza was triggered by Hamas's Oct. 7 attack, which by its tallies killed 1,200 with 253 taken hostage. The subsequent Israeli bombardment has killed more than 33,000 Palestinians, according to Palestinian medics, and displaced the majority of Gaza's 2.3 million people.

(Reporting by Nidal al-Mughrabi in Cairo and Ali Sawafta in Ramallah; additional reporting by Emma Farge in Geneva; Writing by Nidal al-Mughrabi, William Maclean)

Copyright 2024 Thomson Reuters .

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Delivering clinical tutorials to medical students using the Microsoft HoloLens 2: A mixed-methods evaluation

• Murray Connolly 1 ,
• Gabriella Iohom 1 ,
• Niall O’Brien 2 ,
• James Volz 2 ,
• Aogán O’Muircheartaigh 3 ,
• Paschalitsa Serchan 3 ,
• Agatha Biculescu 3 ,
• Kedar Govind Gadre 3 ,
• Corina Soare 1 ,
• Laura Griseto 3 &
• George Shorten 1  

BMC Medical Education volume  24 , Article number:  498 ( 2024 ) Cite this article

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Metrics details

Mixed reality offers potential educational advantages in the delivery of clinical teaching. Holographic artefacts can be rendered within a shared learning environment using devices such as the Microsoft HoloLens 2. In addition to facilitating remote access to clinical events, mixed reality may provide a means of sharing mental models, including the vertical and horizontal integration of curricular elements at the bedside. This study aimed to evaluate the feasibility of delivering clinical tutorials using the Microsoft HoloLens 2 and the learning efficacy achieved.

Following receipt of institutional ethical approval, tutorials on preoperative anaesthetic history taking and upper airway examination were facilitated by a tutor who wore the HoloLens device. The tutor interacted face to face with a patient and two-way audio-visual interaction was facilitated using the HoloLens 2 and Microsoft Teams with groups of students who were located in a separate tutorial room. Holographic functions were employed by the tutor. The tutor completed the System Usability Scale, the tutor, technical facilitator, patients, and students provided quantitative and qualitative feedback, and three students participated in semi-structured feedback interviews. Students completed pre- and post-tutorial, and end-of-year examinations on the tutorial topics.

Twelve patients and 78 students participated across 12 separate tutorials. Five students did not complete the examinations and were excluded from efficacy calculations. Student feedback contained 90 positive comments, including the technology’s ability to broadcast the tutor’s point-of-vision, and 62 negative comments, where students noted issues with the audio-visual quality, and concerns that the tutorial was not as beneficial as traditional in-person clinical tutorials. The technology and tutorial structure were viewed favourably by the tutor, facilitator and patients. Significant improvement was observed between students’ pre- and post-tutorial MCQ scores (mean 59.2% Vs 84.7%, p  < 0.001).

Conclusions

This study demonstrates the feasibility of using the HoloLens 2 to facilitate remote bedside tutorials which incorporate holographic learning artefacts. Students’ examination performance supports substantial learning of the tutorial topics. The tutorial structure was agreeable to students, patients and tutor. Our results support the feasibility of offering effective clinical teaching and learning opportunities using the HoloLens 2. However, the technical limitations and costs of the device are significant, and further research is required to assess the effectiveness of this tutorial format against in-person tutorials before wider roll out of this technology can be recommended as a result of this study

Peer Review reports

Introduction

Clinical tutorials which include encounters with real patients are recognised as integral elements in medical education [ 1 , 2 , 3 ]. Sir William Osler famously stated that “medicine is learned by the bedside and not in the classroom.” [ 4 ] However, many medical schools are facing challenges in delivering clinical education to students in an environment where there are increasing numbers of students, a limited number of patients and tutors, and increased scrutiny regarding the costs and environmental impacts of travel [ 5 , 6 , 7 , 8 ]. The COVID-19 pandemic also had a significant impact on in-person medical education in many countries, where students’ access to patients was severely curtailed [ 9 , 10 ]..

The argument that medical education requires interactive tutorials on actual patients is supported by various educational theories. Bandura’s Social Learning Theory and Social Cognitive Theory propose that students learn via attention, retention, reproduction and motivation [ 11 , 12 ]. This supports the need for direct observation and modelling of relevant clinical role-models participating in doctor-patient interactions [ 13 , 14 ]..

The Constructivist theory is based on the premise that the act of learning is based on a process which connects new knowledge to pre-existing knowledge [ 15 , 16 ]. Vertical Integration in medical education involves the integration of aspects of the curriculum across time, namely the integration of basic sciences and clinical sciences [ 17 , 18 , 19 ]..

Providing medical education within these frameworks, prioritising student exposure to direct interactions with clinicians and patients, and vertical integration of curriculum material, in situations where physical access to patients may be limited by numbers, logistics or infection control concerns poses a significant challenge to medical schools around the world. Utilising technology to facilitate the delivery of clinical education remotely may present a solution to these issues.

The broadcast of bedside tutorials to a remote location can be delivered using a “third-person” perspective, via a fixed or mobile broadcasting device, or using a first-person perspective, via a device mounted on the tutor. Devices which provide a first-person perspective are typically head-mounted-display devices (HMDs). The capabilities of these devices range widely, from basic two-way communication with a remote location, to devices with Augmented Reality (AR) and Mixed Reality (MR) functions which allow the integration of holographic artefacts into tutorials.

Augmented reality (AR) is a virtual environment that allows the user to view both their physical environment and virtual elements in real-time. Mixed Reality (MR) is an extension of AR which allows the real and holographic elements to interact [ 20 , 21 ]..

The use of AR and MR are expanding in many industries including healthcare, education, engineering, and manufacturing [ 22 , 23 , 24 ]. MR investigated in a variety of settings pertaining to medical education. Many early studies focused on teaching relevant anatomy, and more recently studies have evaluated the use of MR in procedural training, and its use in streaming of clinical ward-rounds to medical students [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]..

Head-mounted-display devices which offer MR experiences are growing in number and capability [ 34 ].The Microsoft HoloLens2 is one such device which enables the creation of an immersive Mixed Reality environment and can superimpose holographic images onto the user’s surroundings.

The HoloLens 2 has a number of specific capabilities which can be utilised in the virtual delivery of in-person clinical tutorials.The device can facilitate educationally effective, three-way communication between students, tutors and patients, as well as facilitating the incorporation of mixed reality elements into tutorials. The MR capabilities may provide a means of sharing holographic artefacts such as images and diagrams, which can allow the vertical and horizontal integration of curricular elements at the bedside.Utilisation of the MR capabilities of the device may improve student experiences and learning, in particular through instructional scaffolding (e.g rendering cell, organ or system pathways proximate to a patient) [ 35 ] Given the device’s connectivity capabilities, students can be in a separate geographical location to the patient and tutor. This has the potential to decrease student travel requirements and enables the delivery of tutorials to students in multiple different locations simultaneously [ 36 ]. The tutorial can also be delivered to a greater number of students than would be practical in a traditional bedside clinical tutorial environment. This can decrease the burden on both tutors and patients in comparison to multiple smaller group sessions. Finally, infection control risks are reduced as only the tutor enters patients’ environments.

Study goals

There is little published research to date which robustly evaluates the use of the HoloLens in replicating bedside tutorials while also incorporating mixed reality elements into the tutorials. The aims of this study are to evaluate the use of the Microsoft HoloLens 2 device to deliver a tutorial on preoperative anaesthetic history and upper airway examination to medical students in a remote location, while incorporating MR holograms in the tutorial delivery. Specific objectives include evaluating the feasibility of delivering tutorials with the HoloLens device, assessing the learning efficacy of these tutorials, and assessing student, tutor, facilitator, and patient perspectives of the tutorials.

This study was approved by the Clinical Research Ethic Committee of the Cork Teaching Hospitals, and the University College Cork Research and Postgraduate Affairs Committee. All participants including students, patients, tutor and technical facilitator provided written informed consent prior to inclusion in the study.

Study population

University College Cork medical students from two cohorts, third year Graduate-Entry and fourth year Direct-Entry medical students attending a tertiary referral teaching hospital for a clinical attachment with the Department of Anaesthesia and Intensive Care Medicine were invited to participate in the study. Both groups are in their second-last year of medical training, and thus have completed modules and examinations in basic medical sciences and clinical practice in the preceding years, with a maximum of 1 week experience in the field of anaesthesia [ 37 , 38 , 39 ]. Patients attending Cork University Hospital for scheduled surgery were selected and approached for consent by tutors according to clinical relevance. All participants were 18 years or over and were deemed capable of providing consent. Each student provided information on their age, gender and previous third-level qualifications.

Tutorial Sturcture

A one-hour tutorial focusing on completing a preoperative history and focused assessment of the upper airway was developed by MC (adjunct clinical lecturer), GI (Senior Clinical Lecturer) and GS (Professor) in line with the University curriculum’s learning objectives. (Fig. 1 ) Tutorials were delivered on a weekly basis to groups of third year Graduate Entry and fourth year Direct Entry medical students across the 2021–2022 academic year.

Preoperative Anaesthetic History and Focused Preoperative Assessment of the upper airway tutorial structure

All tutorials were delivered by one tutor (MC) and assisted by a technical facilitator (NOB), both males aged in their thirties, who enabled the connection between the site of the clinical encounter and nearby tutorial room. The tutor had no prior experience with the HoloLens 2 device or other AR HMDs prior to participation in this study; the facilitator had significant experience in its use. The tutor was given a period of familiarisation with the device which included using the Microsoft “HoloLens Tips” app, which provides a structured tutorial on the various hand gestures used to control the device, as well as a number of practice calls in order to test the network and audiovisual equipment in the tutorial room [ 40 ]. This familiarisation period totalled approximately 3 hours.

During the tutorial, the tutor (MC) interacted with a patient (face to face) in the pre-or postoperative units and remotely with a small group of [ 6 , 7 , 8 , 9 , 10 ] students in a nearby tutorial room. The remote interaction occurred via Hololens 2 worn by the tutor, institutional Wi-Fi (Eduroam), and Microsoft Teams.He demonstrated and explained the techniques of preoperative history taking and preoperative upper airway assessment.

Throughout the patient assessment the tutor interacted both with the patient and with the students as if conducting an in-person tutorial, providing additional information, asking the students pertinent questions, and expanding on the findings of the patient’s history and physical examination. Students communicated with the patient by asking questions via the tutor.

Resources employed

Resources necessary to provide the tutorials via the HoloLens included capital costs of the HoloLens device (€3500) and microphone (€88) as well as annual licence costs of €275 per user ( n  = 4). Human resources employed in developing the tutorials and trialling equipment included approximately 20 hours of training, remote assistance (Microsoft) and collaboration between the tutor (MC), Professor (GS) and facilitator (NOB), as well as 5 hours input from the Senior Clinical Lecturer (GI).

Internet connectivity

An internet connection of at least 1.5mpbs of bandwidth is recommended by Microsoft for best audio, visual and content sharing experience [ 41 ]. Secure, password protected wireless internet access via the University institutional network (Eduroam) was utilised by both tutor and students.

In most tutorials, broadcasts were hosted by an MSI running the Windows 10 operating system, audio was amplified using a Bose SoundLink Mini portable speaker and video was screened via a HDMI cable to a 36″ monitor. In one tutorial students accessed the tutorial via their personal smartphones or laptops. In order to bypass the noise cancellation technology within the HoloLens an external microphone (Saramonic SmartMic+UC L/weight Smartphone Mic USB-C) and 3.5 mm earphone were used.

Dynamics 365 Remote Assist application was used, in-tandem with Microsoft Teams, to host each video call. This connection allowed the students to see the tutors field of vision and hear both the tutor and patient. Hand gestures including the “hand-ray”, “air-tap”, “air-tap and hold” and “start-gesture” were used to control the HMD and manipulate the holographic artefacts. Relevant holographic artefacts were superimposed during the tutorial. This included the insertion of diagramatic representaions of the Mallampati scoring system and Thyromental Distance during the airway assessment portion of the tutorial [Fig. 2 (a) and (b)]. The holographic pointer and “drawing” functions were used by the tutor to highlight relevant upper airway structures and emphasise information on the holographic diagrams [Fig. 2 (c) and (d)].

a Assessment of Mallampati Score. b Assessment of Thyromental Distance. c Identification of thyroid cartilage using holographic pointer. d Illustration of holographic “drawing” function

Assessment of tutor perceptions

Immediately after completion of the first tutorial, the tutor completed a System Usability Scale assessment and on completion of the last tutorial, the tutor and facilitator summarised their perceptions of using the HMD.

Assessment of student perceptions

Immediately after completion of the tutorial, students completed a modified Evaluation of Technology-Enhanced Learning Materials: Learner Perceptions (ETELM-LP) questionnaire in order to assess their perceptions of the tutorial, which incorporated a seven-point Likert Scale and open questions [ 42 ]. Cronbach’s Alpha was calculated after exclusion of question 1 and reverse scoring of questions 13 and 15.

Three students also took part in semi-stuctured interviews via Microsoft Teams. Researchers undertook this study from an interpretive approach [ 43 ]. The interviews were conducted by JV, and followed a template of questions and corresponding probes from which the interviewer expanded as appropriate [Additional file 1 ]. The template served as a foundation from which the interviewer expanded as appropriate. The interviews were recorded and transcribed. Analysis of the interview transcripts and questionnare responses was performed using Dedoose Qualitative Research Software Version 4.3.Qualitative data from interviews and feedback questionnaires were coded thematically in alignment with Clarke and Braun’s suggestions for qualitative analysis [ 44 ]. Following the initial thematic coding, researchers conducted a content analysis to strengthen the interpretation of results. Illustrative quotes were chosen based on the representativeness of the theme or subtheme and the clarity of their intrinsic interpretation. In alignment with current literature, the quotes selected were determined to be illustrative of the point, reflective of patterns observed, and relatively succinct [ 45 ]..

Assessment of patient perceptions

On completion of the tutorials, patients were also asked to complete a mixed quantitative and qualitative questionnaire in order to assess their perceptions of the tutorial.

Assessment of learning efficacy

We carried out a prospective non-comparative study of tutorial efficacy. Students completed a pre-tutorial Multiple Choice Question (MCQ) examination to assess baseline knowledge [Additional file 2 ], and a post-tutorial MCQ two to 3 days later [Additional file 3 ]. Students then completed an end-of-year assessment two to 5 months later consisting of a data interpretation exam and an Objective Structured Clinical Examination (OSCE) which focused on preoperative history taking and preoperative assessment of the upper airway respectively [Additional files 4 and 5 ]. These examinations were written by an investigator and the University Senior Clinical Lecturer in line with University standards. Examination results were converted to percentages and the data interpretation and OSCE results were combined to give a total End-of-Year result.

The Chi-Squared test was used to compare direct-entry and graduate-entry student demographics. Welch’s two-sample t-Test assuming unequal variances was used to compare student group ages. The Shapiro Wilk and Kolmogorov-Smirnov Tests were used to assess to normality of distribution of student assessment scores for data sets less than 50 and greater than 50 respectively. The Mann-Whitney U Test was performed to compare group performance in assessments and overall student performance between the pre- and post-tutorial examinations, and between the post-tutorial and End-of-Year scores. Cohen’s d was calculated for the pre and post-tutorial MCQ scores to assess effect size.

Twelve tutorials were completed involving 12 separate patients and 78 students. Four students did not complete the post-tutorial MCQ and one did not complete the End-of-Year assessments due to illness related absences. These students were excluded from efficacy calculations. Baseline characteristics of the student participants are summarised in Table 1 . As expected the graduate-entry students was a significantly older cohort (graduate-entry median age 26 vs direct-entry mean of 22). Mean age of patient participants was 43.25, with an SD of 16.48, and a range of 18–64.

Feasibility

We found that it was feasible to use the HoloLens2 to facilitate weekly bedside tutorials on live patients in a busy, tertiary referral teaching hospital. No tutorials were cancelled or postponed due to technology-related issues. Of note, in order to improve the audio quality of the patient’s voice, it was neccessary to add the USB microphone, which is not routinely supplied with the HoloLens 2. The tutorials were also dependent on secure Wi-Fi access for both tutor and students, the presence of a tutorial facilitator to control the equipment at the student end, and access to a quiet space to examine the patient.

Tutor feedback

The sole tutor (MC) completed the System Usability Scale score, which was 72.5 (a score > 68 is deemed above average). The tutor (MC) stated that the HoloLens 2 was found to be comfortable to wear, the visor was unobtrusive and did not interfere with interaction with the patient or impede visualisation of clinical signs. The interaction with the device via hand gestures was relatively smooth and intuitive after the intial familiarisation period and the MR functions including the insertion of holographic diagrams, pointing, drawing and highlighting were useful. The holographic artefacts were visible throughout the tutorials at a “brightness” setting of seven out of 10.

Occasionally when talking to the students via the HMD, it was not clear to the patient if the tutor was talking to the patient or to the students. Utilising a structured pattern of speech such as “I am now talking to the students” was found to be useful to overcome this issue.

Facilitator feedback

The technical facilitator (NOB) found that the set-up of the live broadcast to the students was akin to that of a video presentation and that the learning curve for hosting the tutorials was short as the Dynamic 365 Remote Assist application was quite similar to general videoconferencing software. He noted that patient proximity to the tutor was essential to ensure adequate audio quality and referenced an example where a supine patient was farther from the device than normal and that patient responses had to be repeated by the tutor. Backgound noise was noted as a “minor issue and transient in nature”, and the technical facilitator accepted that a certain amount of background noise was unavoidable in an active hospital ward.

Student feedback

Quantitative student feedback via the modified ETELM-LP questionnaire is summarised in Fig. 3 . Results are presented as (mean, SD) and refer to a seven-point Likert scale. Students had little experience in MR prior to the tutorial (1.7, 1.29). They found the audio and visual quality was clear and that the MR elements of the tutorial were useful. Most agreed the tutorial approximated a live patient encounter (5.69, 1.26), was more beneficial than a PowerPoint-based tutorial, and were neutral when asked if it was as beneficial as a live clinical encounter (5, 1.69). They did not agree that the tutorial structure required inappropriately high technology skill levels on the part of the students, nor that the MR elements served as a distraction. Most agreed that they would like MR to be incorporated into further tutorials (6.05, 1). Cronbach’s Alpha, excluding question 1 was calculated as 0.86, displaying good internal consistency.

Student Modified ETELM-LP Scores. 7 point Likert scale with 7 as strongly agree and 1 as strongly disagree. Presented as Mean +/− 1 Standard Deviation

Student qualitative feedback results

Analysis of written and verbal feedback from 78 students identified 90 specific positive excerpts and 62 negatives (Table 2 ). Positive feedback included the technology’s ability to broadcast the tutor’s point-of-vision, the inclusion of holographic artefacts, and the remote nature of the tutorial. Negative feedback included issues with the audio-visual stream quality, the fact that students were not able to individually carry out the practical examination, and 11 students expressed concerns that the tutorial was not as useful as traditional in-person bedside clinical tutorials.

Three students participated in semi-structured interviews. The limited sense of “presence” and interaction with the patient were identified as limitations to the format by all three interviewees. With respect to the physical examination one student explained he would have preferred to “experience it yourself, and have a look and feel and touch”. Specific mention was made of the value of combining broadcast (patient) and rendered (schematics) images, “The adding of the images … right next to the patient was really, really helpful”. This may indicate the potential to employ this format to support vertical and horizontal integration of curricular elements. All three interviewed students reported either a six or seven (on a verbal scale of 1–7) when asked to recommend this technology for inclusion in the medical curriculum.

Patient feedback

Quantitative feedback data from patient questionnaires is summarised in Fig. 4 . Most patients had little experience with MR in the past (mean, SD: 1.75, 1.48) apart from one patient who scored 6. All agreed that the communication with the tutor was clear, that they felt safe, that the experience was enjoyable and that they would participate in a similar session in the future. Six of seven expressed that it was preferable to both small (5 or less) and large group in-person tutorials. Most patients did not agree that the HoloLens served as a distraction or made them uncomfortable.

Patient Feedback Questionnaire Results. 7 point Likert scale with 7 as strongly agree and 1 as strongly disagree. Presented as Mean +/− 1 Standard Deviation

Five patients gave qualitative feedback. Positive comments included that “it is good to see that you are moving on with new technology”, “it was well explained beforehand so I was very comfortable” and “it was fantastic to teach students when they can’t be at the bedside. Very unobtrusive”. One patient commented that “sometimes not sure if he [the tutor] was talking to me or the students” and another commented that “it would be lovely to see who I was talking to [the student group]”.

Learning efficacy

Student examination scores are sumarised in Table 3 and Fig. 5 . Student assessment scores were not normally distrubuted. A statistically significant improvement was observed between overall students’ pre and post tutorial MCQ scores (mean 59.2% Vs 84.7%, p  < 0.001). Cohen’s d was 0.612, indicating a medium effect size. There was a statistically significant difference in student performance between the post tutorial MCQ and the composite End-of-Year scores (84.7% Vs 82.2%, p  < 0.05). There were no statistically significant differences found between the graduate-entry and direct-entry students for any individual examination.

Boxplot of overall student assessment scores

Mixed Reality headsets offer several novel capabilities which can facilitate remote education and vertical and horizontal integration of curriculum elements, particularly when aligned with appropriate educational theories such as Constructivism and Social Cognitive Theory. A large number of studies have focused on applying the technology in surgical and anatomical subject fields [ 46 ]. However, there are significant gaps in the evidence base, particularly studies specific to anaesthesiology, clinical exam, and addressing the provision of interactive tutorials to remote locations. Our study has demonstrated that it is feasible and effective to use the Microsoft HoloLens 2, incorporating its Mixed Reality functions to provide a live bedside tutorial on anaesthetic preoperative assessment to students situated in a remote location. Feedback from students, patients and the tutor were generally positive. Quantitative feedback from students regarding the audio-visual quality was mainly positive, however technical issues were noted, and preference for in-person tutorials was expressed by a minority of students.

Mill et al. previously examined the feasibility of the HoloLens 2 in broadcasting medical ward rounds [ 26 ]. While papers such as that by Mill et al. demonstrated the feasibility of utilizing the HoloLens 2 HMD to stream educational ward-rounds, they did not utilize the MR functions of the HMD, nor assess the learning efficacy of the device [ 26 ]. This study incorporates both quantitative and qualitative feedback from multiple sources, namely students, patients, the tutor, and tutorial facilitator. We believe this demonstrates a robust examination of the perceptions of the relevant stakeholders involved in the provision of clinical tutorials to medical students. Our findings that the tutorials were feasible, agreeable to both patients and students, and that students had occasional audio-visual difficulties are consistent with those of Mill et al. Our study additionally demonstrates that incorporation of holographic artefacts is both feasible and regarded by the tutor and students as useful, and that the tutorials provide effective knowledge acquisition.

Our tutorial format aimed to reproduce some of the educationally relevant components of an in-person tutorial. Other suggested structures advocate streaming video of the physician as opposed to the physician’s point-of-view [ 47 ]. The HoloLens 2 device allows the students to view the tutor’s field of vision which we argue is superior, and student feedback reflected this. This viewpoint allows students to appreciate in real time the clinical signs demonstrated during the clinical examination and correlate these with the holographic diagrammatic examples used. The MR environment provides an ideal setting to facilitate vertical integration in real time by displaying holographic artefacts of anatomical, physiological and pathological information, as well as patient specific data such as radiological imaging or lab results while interacting with a patient. Furthermore, delivering tutorials remotely reduces infection-control concerns and allows delivery to greater numbers of students in multiple locations.

Preserving patient confidentiality is essential in medical practice and education. In our study, both the HMD and devices at the student end were connected to secure institutional Wi-Fi and accessed via University accounts. Also, access to the audio-visual stream was controlled by the technical facilitator, and the students were located in a supervised tutorial room. It would be essential to control both access to the tutorial and the environment to which it is broadcast to maintain confidentiality.

Limitations

Our study design has a number of limitations. It is non-comparative, and thus we are unable to draw conclusions regarding the relative learning experience or efficacy associated with tutorials delivered via the HoloLens device and the more traditional in-person bedside tutorials. Additionally, the different assessment methods between the MCQs and end of year examinations make direct measurement of knowledge retention difficult. The number of patients involved in the study was relatively small, and thus interpretation of both quantitative and qualitative data must be viewed in this context, and the generalisability of the data is low. The feedback from the tutor and tutorial facilitator must be viewed in the context that they were study investigators.

There are a number of limitations specific to research involving the HoloLens. Common limitations in studying the learning effects of the HoloLens in tested roles include the absence of validated measures and comprehensive evaluation instruments. Unlike other technologies, there are no benchmarks, datasets, or standard standardized protocols to specifically evaluate augmented reality systems, experiences, and methodologies [ 48 , 49 , 50 ]. Although the viewpoint offered to the students by the HoloLens allows the students to appreciate what the tutor is demonstrating, one drawback to this is that the focus of attention is primarily controlled by the tutor, and thus it is difficult for the tutorial to challenge the students to select the relevant areas to attend to. Depending on the tutorial topic and structure, an ideal virtual format may provide three perspectives: the tutors view, a third person view of the clinical encounter, and where applicable, an instrument’s view.

Regarding the generalisability of our study to other tutorial topics, the appreciation of clinical signs which would require palpation or auscultation would be beyond the current capabilities of the HoloLens 2 and therefore, careful tutorial design and topic selection is necessary.

Our results demonstrate the feasibility of facilitating remote bedside tutorials on preoperative anaesthetic assessment using the HoloLens 2. The tutorial structure was found to be agreeable to students, patients, and tutors. Provision of tutorials in the format described in this study may be an option for situations where students’ access to live bedside tutorials are limited. However, further research is required to characterise the role, potential and limitations of incorporating Mixed Reality into clinical medical education in a broader context. Poor audio-visual quality and lack of hands-on practice were found to be the most frequent issues identified in our study and may be significant limitations to the use of this technology in wider medical education. There are significant costs involved in developing the infrastructure and expertise necessary to provide tutorials in this format. Prior to this technology being adopted by educational institutions, we recommend the completion studies to compare the learning efficacy of MR facilitated remote tutorials and traditional in-person bedside tutorials.

Availability of data and materials

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

Abbreviations

• Augmented Reality

Evaluation of Technology-Enhanced Learning Materials: Learner Perceptions

Head-Mounted Display

Interquartile Range

Multiple Choice Question

• Mixed Reality

Objective Structured Clinical Examination

Standard Deviation

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Acknowledgements

The authors would like to acknowledge the assistance from members of the UCC College of Medicine and Health, including Dr. Colm O’Tuathaigh, Dr. Gabriella Rizzo, Dr. Pat Henn and Professor Paula O’Leary, as well as Ms. Michelle Donovan in the UCC Centre for Digital Education.

This study received funding and research support through the UCC Learning Analytics LITE programme, which is funded through the Strategic Alignment of Teaching and Learning Enhancement fund. The UCC Learning Analytics LITE programme provided logistical and research support in study design and funds were used to hire assistance in data interpretation.

This study also received funding from the UCC College of Medicine and Health which was utilised to purchase the HoloLens 2 Device and associated licences.

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Murray Connolly, Gabriella Iohom, Corina Soare & George Shorten

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MC lead the design of the study, carried out the tutorials, analysed both quantitative and qualitative data and was the primary author of the manuscript. GI contributed to the design of the study, the student examinations contributed to writing the manuscript. NOB contributed to the technical and logistical design of the study and acted as technical facilitator for the tutorials and contributed to manuscript composition. JV designed, completed and analysed the semi-structured student interviews and contributed to manuscript composition. AOM, PS, AB, LG and supervised and analysed student examination data. KGG analysed student demographic data and student examination data. CS contributed to initial evaluation of the HoloLens device and tutorial design. GS played a central role in study design and completion and was a major contributor in manuscript composition.

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Correspondence to Murray Connolly .

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This study was approved by the Clinical Research Ethic Committee of the Cork Teaching Hospitals, and the University College Cork Research and Postgraduate Affairs Committee. All methods were carried out in accordance with guidelines and regulations as set out by the ethics and research committees. All participants provided informed consent to participate in the study.

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Connolly, M., Iohom, G., O’Brien, N. et al. Delivering clinical tutorials to medical students using the Microsoft HoloLens 2: A mixed-methods evaluation. BMC Med Educ 24 , 498 (2024). https://doi.org/10.1186/s12909-024-05475-2

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What’s life like for Russia’s political prisoners? Isolation, poor food and arbitrary punishment

(AP Illustration/Peter Hamlin)

FILE - Russian opposition activist Vladimir Kara-Murza gestures while standing in a defendants’ cage in a courtroom in Moscow, Russia, on July 31, 2023. Kara-Murza was convicted of treason over a speech denouncing the conflict in Ukraine. He is serving a 25-year prison term in a Siberian prison colony, the stiffest sentence for a Kremlin critic in modern Russia. (AP Photo, File)

FILE - A double fence that is part of a museum commemorating victims of Soviet-era political repressions, stands inside a former prison camp, some 110 kilometers (69 miles) northeast of the Siberian city of Perm, Russia, on March 6, 2015. Historians estimate that under Soviet dictator Josef Stalin, 700,000 people were executed during the height of his purges in 1937-38. In modern Russia, former inmates, their relatives and human rights advocates paint a bleak picture of the prison system that is descended from the USSR’s gulag. For political prisoners, life inside is a grim reality of physical and psychological pressure. (AP Photo/Alexander Agafonov, File)

FILE - Prisoners’ beds stand in a barracks in a museum housed in a former prison camp, some 110 kilomeeters (69 miles) northeast of the Siberian city of Perm, Russia, on March 6, 2015. Historians estimate that under Soviet dictator Josef Stalin, 700,000 people were executed during the height of his purges in 1937-38. In modern Russia, former inmates, their relatives and human rights advocates paint a bleak picture of the prison system that is descended from the USSR’s gulag. For political prisoners, life inside is a grim reality of physical and psychological pressure. (AP Photo/Alexander Agafonov, File)

FILE - Russian opposition activist Vladimir Kara-Murza, standing in a defendants’ cage, speaks with his lawyer in a courtroom in Moscow, Russia, on July 31, 2023. Kara-Murza was convicted of treason in 2023 for denouncing the conflict in Ukraine and is serving a 25-year prison term in a Siberian prison colony, the stiffest sentence for a Kremlin critic in modern Russia. (AP Photo/Dmitry Serebryakov, File)

FILE - Prisoners walk inside Corrective Labor Colony No. 22 in the village of Leplei, some 600 kilometers (375 miles) southeast of Moscow, on Nov. 13, 1996. Former inmates, their relatives and human rights advocates paint a bleak picture of Russia’s prison system that is descended from the USSR’s gulag. For political prisoners, life inside is a grim reality of physical and psychological pressure. (AP Photo/Alexander Zemlianichenko, File)

FILE – An unidentified prisoner holds a piece of bread inside Corrective Labor Colony No. 22 in the village of Leplei, some 600 kilometers (375 miles) southeast of Moscow, on Nov. 13, 1996. Former inmates, their relatives and human rights advocates paint a bleak picture of Russia’s prison system that is descended from the USSR’s gulag. For political prisoners, life inside is a grim reality of physical and psychological pressure. (AP Photo/Alexander Zemlianichenko, File)

FILE - Prisoners inside Moscow’s 18th century Butyrka prison talk to officials and a visiting British delegation on June 5, 2002. Former inmates, their relatives and human rights advocates paint a bleak picture of Russia’s prison system that is descended from the USSR’s gulag. For political prisoners, life inside is a grim reality of physical and psychological pressure. (AP Photo, File)

FILE - Russian opposition leader Alexei Navalny is seen via a video link to a courtroom in Moscow, Russia, on Oct. 18, 2022. Navalny, who died in a remote Arctic penal colony on Feb. 16, 2024, spent months inside a punishment cell for such infractions as not buttoning his uniform properly or not putting his hands behind his back when required. (AP Photo, File)

FILE - This photo taken from video shows a view of the prison colony in the town of Kharp, in the Yamalo-Nenetsk region about 1,900 kilometers (1,200 miles) northeast of Moscow, Russia, on Tuesday, Feb. 20, 2024. The penal colony is where opposition leader Alexei Navalny died on Feb. 16, 2024, according to Russian prison officials. (AP Photo, File)

FILE - Warden Lt. Col. Leonid Siliverstov, left, stands in a cell with inmates on June 6, 2002, at the Sergiev Posad pretrial holding facility about 80 kilometers (50 miles) north of Moscow. Former inmates, their relatives and human rights advocates paint a bleak picture of Russia’s prison system that is descended from the USSR’s gulag. For political prisoners, life inside is a grim reality of physical and psychological pressure. (AP Photo, File)

FILE - Penal Colony No. 2, known for its particularly harsh conditions, is seen in Pokrov, in the Vladimir region, 85 kilometers (53 miles) east of Moscow, Russia, on Feb. 28, 2021. Former inmates, their relatives and human rights advocates paint a bleak picture of Russia’s prison system that is descended from the USSR’s gulag. For political prisoners, life inside is a grim reality of physical and psychological pressure. (AP Photo/Kirill Zarubin, File)

FILE - Nadezhda Tolokonnikova, center, a member of the Pussy Riot punk group, smiles in front of journalists as she stands in front of a police line outside a court in Moscow, Russia, Feb. 24, 2014. Tolokonnikova, who was in prison for nearly 22 months in 2012-13, recalls working 16-18-hour shifts sewing uniforms while at Penal Colony No. 14 in the Mordovia region, (AP Photo/Alexander Zemlianichenko, File)

FILE - A man holds portrait of a victim of Soviet-era political repression as other people lay flowers and light candles at a monument in front of the former KGB headquarters in Moscow, Russia, on Oct. 29, 2018, to remember victims of Soviet dictator Josef Stalin. The monument is a large stone from the Solovetsky Islands, where the USSR’s gulag prison system was established. (AP Photo/Alexander Zemlianichenko, File)

FILE - Police officers in face masks to protect against the coronavirus stand guard at Penal Colony No. 2 in Pokrov in the Vladimir region, 85 kilometers (53 miles) east of Moscow, Russia, on April 6, 2021. The sign outside the colony, known for its strict conditions, reads “Security zone.” Former inmates, their relatives and human rights advocates paint a bleak picture of Russia’s prison system that is descended from the USSR’s gulag. For political prisoners, life inside is a grim reality of physical and psychological pressure. (AP Photo/Denis Kaminev, File)

FILE - Andrei Pivovarov, former head of the Open Russia movement, stands in a defendants’ cage during court in Krasnodar, Russia, on June 2, 2021. Pivovarov is serving four years in prison for running a banned political organization. He must clean his solitary confinement cell for several hours a day and listen to recordings of prison regulations, according to his wife, Tatyana Usmanova. (AP Photo, File)

FILE - Alexei Gorinov holds a sign reading, “I am against the war,” while standing in a defendants’ cage in a courtroom in Moscow, Russia, on June 21, 2022. Gorinov is serving seven years for speaking out against Russia sending troops to Ukraine. His supporters say he suffers from a respiratory condition and his health has deteriorated during six weeks in solitary confinement. (AP Photo, File)

FILE - A view of the entrance of the prison colony in the town of Kharp, in the Yamalo-Nenetsk region about 1,900 kilometers (1,200 miles) northeast of Moscow, Russia, on Sunday, Feb. 18, 2024. The penal colony is where opposition leader Alexei Navalny died on Feb. 16, 2024, according to Russian prison officials. (AP Photo, File)

FILE - In this handout photo taken from video provided by the Moscow City Court on Feb. 2, 2021, Russian opposition leader Alexei Navalny shows a heart symbol while standing in a defendants’ cage during a hearing in the Moscow City Court in Moscow, Russia. Navalny, who died in an Arctic penal colony on Feb. 16, spent months in punishment cells for infractions like not buttoning his uniform properly or not putting his hands behind his back when required. (Moscow City Court via AP, File)

FILE - Oleg Navalny, the brother of Alexey Navalny, poses for media in Berlin, Germany, on Jan. 24, 2023, inside a replica of a punishment cell where the Russian opposition leader spent time in 2022. For political prisoners, life in Russia’s penal colonies and labor camps is a grim reality of physical and psychological pressure, insufficient food, poor health care, sleep deprivation and arbitrary rules that are impossible to obey. Now, with the still-unexplained death of Alexei Navalny this month in an Arctic prison, human rights advocates fear that no one behind bars is safe. (AP Photo/Markus Schreiber, File)

FILE - A replica of Russian opposition leader Alexei Navalny’s jail cell from last year that was installed on a square near the Louvre Museum in Paris is pictured on March 14, 2023. For political prisoners, life in Russia’s penal colonies and labor camps is a grim reality of physical and psychological pressure, insufficient food, poor health care, sleep deprivation and arbitrary rules that are impossible to obey. Now, with Navalny’s still-unexplained death this momth in an Arctic penal colony, human rights advocates fear that no one behind bars is safe. (AP Photo/Thomas Padilla, File)

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This story is part of a larger series on the crackdown on dissent in Russia. Click here to read more of those stories , and the AP’s coverage of Russia’s presidential election.

TALLINN, Estonia (AP) — Vladimir Kara-Murza could only laugh when officials in Penal Colony No. 6 inexplicably put a small cabinet in his already-cramped concrete cell, next to a fold-up cot, stool, sink and latrine.

That moment of dark humor came because the only things he had to store in it were a toothbrush and a mug, said his wife, Yevgenia, since the opposition activist wasn’t allowed any personal belongings in solitary confinement.

Another time, she said, Kara-Murza was told to collect his bedding from across the corridor — except that prisoners must keep their hands behind their backs whenever outside their cells.

“How was he supposed to pick it up? With his teeth?” Yevgenia Kara-Murza told The Associated Press. When he collected the sheets, a guard with a camera appeared and told him he violated the rules, bringing more discipline.

For political prisoners like Kara-Murza, life in Russia’s penal colonies is a grim reality of physical and psychological pressure, sleep deprivation, insufficient food, health care that is poor or simply denied, and a dizzying set of arbitrary rules.

This month brought the stunning news from a remote Arctic penal colony, one of Russia’s harshest facilities: the still-unexplained death of Alexei Navalny , the Kremlin’s fiercest foe.

“No one in the Russian penitentiary system is safe,” says Grigory Vaypan, a lawyer with Memorial, a group founded to document repression in the Soviet Union, especially from the Stalinist prison system known as the gulag.

“For political prisoners, the situation is often worse, because the state aims to additionally punish them, or additionally isolate them from the world, or do everything to break their spirit,” Vaypan said. His group counts 680 political prisoners in Russia.

Kara-Murza was convicted of treason last year for denouncing the war in Ukraine. He is serving 25 years, the stiffest sentence for a Kremlin critic in modern Russia, and is among a growing number of dissidents held in increasingly severe conditions under President Vladimir Putin’s political crackdown.

THE GULAG’S LEGACY

Former inmates, their relatives and human rights advocates paint a bleak picture of a prison system that descended from the USSR’s gulag, documented by Alexander Solzhenitsyn in “One Day in the Life of Ivan Denisovich” and “The Gulag Archipelago.”

While undergoing reforms, it “more or less still has the backbone of the Soviet system,” says Oleg Kozlovksy, Amnesty International’s Russia researcher.

Most often, inmates live in barracks tightly packed with bunk beds. Konstantin Kotov, an activist who spent over a year in Penal Colony No. 2 in the Vladimir region — Navalny’s prison from 2021 until June 2022 — recalls cramped quarters of up to 60 men per room.

Not even the pandemic changed that, Kotov told AP. Masks were required from 6 a.m. until 10 p.m., but he doubts they helped much. “Every now and then, people had high fever. They were taken to the infirmary, then brought back, and that was it,” he said.

Meals are basic and unsatisfying.

Breakfast was porridge, lunch was soup with little or no meat, mashed potatoes and a meat or fish cutlet; as was dinner, Kotov said. Inmates got two eggs a week, and fruit and vegetables were a luxury almost always sold out at prison kiosks, he added.

“The ration is not enough, and often it’s inedible. So almost no one lives on rations alone,” Navalny once said. His wife described his meals as porridge for breakfast, soup and porridge for lunch, and porridge with herring for dinner.

Additional food is sold, or relatives can send parcels, within limits. Those in punishment cells get no packages.

There is a strict regimen of menial tasks and duties, like cleaning and standing at attention.

Andrei Pivovarov, serving four years for running a banned political organization, must clean his solitary cell for several hours a day and listen to a recording of prison regulations, says his wife, Tatyana Usmanova. But he can’t do both at the same time, or finish quickly and rest, she added. Guards watching via CCTV punish rule-breakers.

A “SYSTEM OF SLAVERY”

There are just under 700 penitentiary facilities in Russia, and most are penal colonies of varying security, from minimum to “special regime.” There are about 30-40 penal colonies for women.

Political prisoners tend to be sent to those whose administrations hold tighter controls, says Zoya Svetova, a journalist and prisoner rights advocate.

Inmates are required to work, but often there are not enough tasks for men. Women usually sew uniforms for the military, police and construction workers, working long hours for meager pay, said prisoner advocate Sasha Graf.

Nadya Tolokonnikova, a member of Pussy Riot protest group who was in prison for nearly 22 months in 2012-13, recalls sewing for 16- to 18-hour shifts. “It’s a system of slavery, and it is truly horrible,” she told AP.

Inmates are supposed to be paid not less than minimum wage -– 19,242 rubles (about $200) a month in 2024 -– but in reality it’s as little as 300 rubles (about $3.20) — enough to buy cigarettes and sanitary products at the prison kiosk, Graf said.

INTIMIDATION AND REPRESSION

Tolokonnikova said when she arrived at Penal Colony No. 14 in the Mordovia region, the warden described himself as a “Stalinist.” She said he told her: “You may be a somebody outside of this colony, have a voice, people who support you and care for you, but here, you are in completely in my power, and you need to understand this.”

Although prisons are technically overseen by commissions that do inspections and advocate for inmates, their members in recent years have been replaced by government loyalists, says Svetova, who served on a commission from 2008-16.

She said the current government uses prisons for intimidation and oppression.

Reports of physical abuse are common for ordinary inmates but rare for political prisoners, advocates say. Instead, intimidation often comes via enforcing minor infractions, said Amnesty’s Kozlovsky.

Navalny spent months in a punishment cell for not buttoning his uniform properly or not putting his hands behind his back when required. He once described it as a “concrete kennel” of 2½-by-3 meters (8-by-10-feet) that, depending on the season, was “cold and damp,” or “hot and there’s almost no air.”

Long stints in punishment cells or other types of solitary confinement are a reality for many, and their only lifeline is a visit from a lawyer or writing letters that are censored and sometimes take weeks to arrive; some colonies use a faster online service.

A TOLL ON PRISONERS’ HEALTH

Health care is almost nonexistent, current and former inmates and advocates say, with only basic drugs available, if at all.

“Prison guards by default believe the inmate is faking and only complaining about health issues to get some kind of extra privileges,” said Tolokonnikova.

Not surprisingly, inmates don’t fare well in such conditions.

Yevgenia Kara-Murza said her 42-year-old husband’s health has worsened in solitary.

He suffered two near-fatal poisonings in 2015 and 2017 and developed polyneuropathy, a condition that deadens the feeling in his limbs. While he received some treatment in pretrial detention in Moscow, there has been none at the penal colony in Omsk.

“He needs physical therapy, exercise,” which is hardly possible in his cell, she said.

Alexei Gorinov, a former member of a Moscow municipal council serving seven years for speaking against the war in Ukraine, suffers from a chronic respiratory condition and had part of a lung removed before imprisoned. His health deteriorated during six weeks in solitary confinement, and he is still recovering.

In December, Gorinov, 62, was not strong enough to sit up in a chair or even speak, his allies quoted his lawyer as saying. Eventually moved to a prison hospital, he is still awakened every two hours because he’s labeled a flight risk and authorities must regularly confirm his whereabouts, supporters say. He considers it a form of torture.

While public pressure helped stop prison abuses in recent years, Memorial’s Vaypan believes a line has been crossed with Navalny’s death.

It’s a “worrying signal” that things could get worse, he said.