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The UDL Guidelines are a tool used in the implementation of Universal Design for Learning, a framework to improve and optimize teaching and learning for all people based on scientific insights into how humans learn. Learn more about the Universal Design for Learning framework from CAST. The UDL Guidelines can be used by educators, curriculum developers, researchers, parents, and anyone else who wants to implement the UDL framework in a learning environment. These guidelines offer a set of concrete suggestions that can be applied to any discipline or domain to ensure that all learners can access and participate in meaningful, challenging learning opportunities.

Reenvisioning the UDL Guidelines

Because the UDL Guidelines are meant to be informed by feedback from the field as well as new research, they have been updated several times in the past. We are in the process of updating the Guidelines once again.

This update will focus specifically on addressing systemic barriers that result in inequitable learning opportunities and outcomes. CAST aims to develop a transparent, inclusive, and community-driven process. If you are interested in collaborating and staying updated on our progress, we invite you to complete a brief survey.

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The UDL Guidelines are a tool used in the implementation of Universal Design for Learning, a framework to improve and optimize teaching and learning for all people based on scientific insights into how humans learn. Learn more about the Universal Design for Learning framework from CAST. The UDL Guidelines can be used by educators, curriculum developers, researchers, parents, and anyone else who wants to implement the UDL framework in a learning environment. These guidelines offer a set of concrete suggestions that can be applied to any discipline or domain to ensure that all learners can access and participate in meaningful, challenging learning opportunities.

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When I began studying students' experience of belonging 20 years ago, people weren't talking so much about belonging. But now, we're constantly told we belong. A notepad on my desk assures me, "You belong." A button I was handed at a school meeting says the same. And the other day, I saw yet another sign, firmly planted in an elementary school garden: "You belong!"

Hooray! Kudos for us!

Make no mistake, belonging is important. My colleagues and I have developed strategies to support a sense of belonging for students and have shown their effects in experiment after experiment with control groups to identify causal relationships. Through this work, we've found that, in middle and high school, a lack of belonging causes worse attendance, lower grades, and disciplinary problems. In college, belonging concerns sap motivation and contribute to inequality in achievement-and life success.

Why then do I feel a pit in my stomach every time I hear, "You belong!"? It's because that phrase doesn't do the job. It might even make things worse. As we stumble through a pandemic, with all the worry, isolation, and grief it has caused, and as we try to rebuild our communities in schools, that's the last thing we need.

I'm teaching a first-year seminar at Stanford University now, and my students are thrilled to be on campus. But they left new student orientation bruised and battered by the onslaught of "You belong!" One student said, "The constant reiteration of 'you belong here' made me doubt that it's true since they felt the need to repeat it with such fervor and frequency." Thou doth protest too much, dear Stanford.

In general, when students wonder whether they belong, they have excellent reasons. School transitions are always taxing: Friendships and ways of learning are disrupted. Questions of belonging also often fall along group lines. Students of color confront the legacy of racial segregation in American schooling and racist stereotypes that imply lesser intelligence. Low-income students hear their group described as "vulnerable" and experience a cultural mismatch in school settings organized for their wealthier peers. And girls and women encounter negative stereotypes in math and science. These are realities. They provoke students to ask again and again, "Is school really for me? Is this a place where people like me can truly belong, learn, and succeed?"

Simply telling students, "You belong!" ignores their legitimate concerns. Worse yet, it shifts the onus to the student: We've assured you that you belong. If you still don't think you belong, that's your problem.

It's especially touchy when the message seems targeted at just those students with the greatest reasons to question their belonging-the lone woman in an engineering class, the Black student surrounded by white peers, the low-income student among wealthier classmates. These are the students who need sensitive support, not glib reassurance.

How can we provide this support? It takes wisdom, planning, and hard work. Here are three lessons, all drawn from research.

First, we should talk about how difficult school transitions are. As a graduate student, I interviewed 7 th graders about their experience coming to middle school. They worried they would forget their locker combination, that they might get lost. For African American students, these worries were laced with a growing awareness of racial stereotypes. Would people treat them fairly?

What can we do? We can make it obvious that worries about belonging are normal, that they are felt by everyone, albeit in their own way, and that the worries can wane with time. The teachers of both my 6- and 9-year-olds read Julie Danneberg's First Day Jitters to their classes early this year. It tells the story of how even a teacher is anxious on the first of school. (One wonderful teacher even shared her own feelings of nervousness!)

Research finds that talking about belonging as a process, as improving even if never quite complete, can ease transitions to middle school, high school, and college, raising achievement and reducing inequalities over years. One way to do this is to host well-structured conversations: how belonging worries are normal, why they come up, and how students and teachers can work together to make things better.

Second, we should support students' diverse identities and recognize them as sources of motivation and success. The fact is many students we serve have identities that cast them in pejorative terms, that pose them as weak or dumb or violent and therefore as undeserving of educational opportunities. So, it's important to honor and support positive representations of students' groups and identities. Well-done ethnic-studies courses can raise attendance and grades in high school. Tiffany Brannon at the University of California, Los Angeles, emphasizes a "pride and prejudice" approach to belonging-support the pride students feel in their groups and reduce the prejudice they face.

Third, we should be explicit that school is about learning and growth, not identifying who's smart. The latter "fixed-mindset" message, even if implicit, is terrifying for students who face the stereotype that people like them aren't as smart as others. The "You belong!" chorus my students heard was especially harmful because it was interspersed with praise for a select few-like the one student who had invented a new form of gene coding.

When we welcome students to school, we should focus on the future, not the past-on the amazing things students can do learning and working together. When we evaluate students' work, we should praise their progress. When we give critical feedback, we should be explicit about our growth-oriented goals-"I'm giving you this feedback because I have high standards and I know you can meet them." That's telling students why you give them feedback-not just "I think you can do it."

The Student Experience Research Network offers more ideas.

If a close friend shared a difficulty in your relationship with you, you wouldn't say, "Don't worry. We're great!" No, you'd talk with them. You'd listen. You'd try your best to understand how they feel, knowing that however they feel is legitimate. Together, you'd chart a path of growth and you'd do your part to follow that path. So it is with students who question their belonging in school.

It's not our job to tell students how they feel. It is our job to create ways of thinking, cultures, and personal relationships that make school a place of genuine belonging for every child.

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Stop Telling Students, 'You Belong!' (Opinion)

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Researcher Greg Walton writes about 3 ways that educators can drop the buzzwords in favor of making a sense of belonging real and valuable.

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Consider increasing the accessibility of your course content by using Universal Design for Learning, an educational framework designed to create flexible learning environments to accommodate individual learning differences.

More than 600 students registered with Student Disability Services during the 2017-2018 academic year. Not all disabilities are visible or disclosed. Types of diagnoses and conditions that can be considered disabilities include but are not limited to:

Attention-Deficit/Hyperactivity Disorders (ADHD)

Autism Spectrum Disorders (ASD)

Blindness (i.e., visually impairments)

Deafness (i.e, hearing impairments)

Learning disabilities (LD)

Mood disorders (i.e., anxiety, depression)

Medical disabilities

Physical disabilities

Psychological disabilities

Traumatic brain injuries

Temporary disabilities

Be proactive: Consider increasing accessibility by including ISBN numbers on your syllabi. This addition can help students find versions of required texts that are adaptable for screen readers or have audible versions. Also, think about including a statement on your syllabus that provides support for students with disabilities.

‍ I recognize that students in this class may have a range of visible and invisible disabilities-cognitive, learning, emotional, psychological, and physical. I welcome all students of various backgrounds and abilities in this class. If any circumstances make our learning environment or activities difficult, please contact Student Disability Services at 773.702.6000 or disabilities@uchicago.edu.

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Diversity & Pedagogy | Inclusive Pedagogy | The University of Chicago

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Consider increasing the accessibility of your course content by using Universal Design for Learning, an educational framework designed to create flexible learning environments to accommodate individual learning differences. More than 600 students registered with Student Disability Services during the 2017-2018 academic year. Not all disabilities are visible or disclosed.

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Survey Results

Standards-Based Health Education and Assessment

Performance assessment offers teachers a way to measure students' knowledge and skills related to instruction in the classroom. In the field of health education, performance assessment shifts the emphasis from knowing health facts to developing health skills, thus providing a more complete and authentic picture of student achievement. Good assessment matches instructional goals and objectives, emphasizes higher-order thinking skills, has criteria that is clear to students and teachers, and provides feedback to students. It should be engaging and relevant to students, reflect real-world situations, and assess content knowledge and skill application.

Long Beach Unified School District (LBUSD) is committed to standards-based health education in conjunction with quality health education assessment. LBUSD utilizes materials from the Chief Council of State School Officers, State Collaborative on Assessment and Student Standards, Health Education Assessment Project (CCSSO~SCASS HEAP) as a foundation for assessment. California is a member of the state collaborative that has developed a bank of over 2,800 health education assessment items. This membership entitles California schools to have free access to these items.

Health Education Content assessed includes:

Personal and Community Health (PCH)

Mental, Emotional and Social Health (MESH)

Nutrition and Physical Activity (NPA)

Injury Prevention and Safety (IPS)

Alcohol, Tobacco and Other Drugs (ATOD)

Growth, Development and Sexual Health (GDSH)

Health Skills assessed include:

Analyzing Influences (AI)

Accessing Valid Information (AVI)

Interpersonal Communication (IC)

Decision Making (DM)

Goal Setting (GS)

Practicing Health-Enhancing Behaviors (PB)

Promoting Health (PH)

Four types of Assessments are used:

1. Selected Response (Multiple Choice Items) require students to select a correct answer from several options.

-- Sample:
Which of these actions would be considered ASSERTIVE communication when you are offered an alcoholic drink?

1. Telling everyone how stupid people are who use alcohol.

2. Saying, "No thanks, I don't drink".

3. Taking a drink, but not drinking it.

4. Getting into an argument with the person.

2. Constructed response (short answer) require students to write one or two paragraphs within a limited amount of time addressing a specific writing prompt. Student responses are scored using a rubric for concepts and a rubric for the specific health skill.

-- Sample:
Pat has been asked to speak briefly to an eighth grade class about secondhand smoke. Write what Pat could say to persuade them to avoid secondhand smoke. Include a definition of secondhand smoke and at least three risks associated with secondhand smoke. Be sure to write it in a way that will convince eighth graders to avoid secondhand smoke.

3. Performance events are curriculum-embedded activities that students complete within a single class period. The student's work includes a written response to a problem situation. Student responses are scored using a rubric for concepts and a rubric for the specific health skill.

-- Sample:
You will be working in small groups to research and demonstrate how to respond to specific injuries or emergency situations. Your teacher will assign the topic to your group. You will need to research your topic from the resources in the classroom. Your group will plan an oral presentation to the class about your topic which will include: a description of the injury or emergency and its symptoms/characteristics, a demonstration of how to respond, and a overhead or handout for the class explaining how to respond to the injury or emergency.

4. Performance tasks are curriculum-embedded, complex projects that students complete within a few class periods or outside of class. While some of the work may be done in groups, one or more components of the project are completely individually. Tasks are intended to assess both health knowledge and health skills. Student responses are scored using a rubric for concepts and a rubric for the specific health skill.

-- Sample:
Record your food intake over a period of three days (at least one of the days needs to be a Saturday or Sunday). Record what you eat, how much, when, and where. Evaluate your food intake by comparing it to the USDAÌs Dietary Guidelines for Americans and Food Guide Pyramid. Determine what nutritional goals you should set based on your evaluation of your food intake and make a plan for reaching those goals.

Rubrics and Scoring:

The CCSSO~SCASS HEAP has developed specific, 4 point rubrics for scoring concepts and skills. The concepts rubric focuses on the student's ability to comprehend health concepts, to make relationships between concepts and to draw conclusions about those relationships. The more comprehensive the response, the higher the score. The skills rubrics focus on proficiency in demonstrating a skill. The determination of proficiency is specific to each skill.

Portfolios:

Students may collect a variety of performance events and tasks in a Health Portfolio. This collection of student work allows the student to showcase his/her best work in the class. Students may use these portfolios to show others what they have learned and what they can do in Health Education.

Portfolios help change the emphases of health education content by placing less emphasis on health facts and more emphasis on health concepts. They help promote the development of health literacy skills by placing less emphasis on health content and getting the answer and more emphasis on health skills and developing a healthy lifestyle. They also help change the emphases of assessment by placing less emphasis on determining what students do not know and more emphasis on what students can do.

Department Info

Department Phone
(562) 997-8105

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Performance assessment offers teachers a way to measure students' knowledge and skills related to instruction in the classroom. In the field of health education, performance assessment shifts the emphasis from knowing health facts to developing health skills, thus providing a more complete and authentic picture of student achievement.

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Health Education Strategies: Assessment in Health Education

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The webinar below provides and overview of developing performance based assessments in health education.

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This piece was revised and expanded for my new book, Undoing the Grade: Why We Grade, and How to Stop, available now in paperback and Kindle editions.
This presentation was offered in collaboration with the Big Questions Institute. A full transcript of the slides is below. And a video of the live presentation is also available.
"Ungrading" means raising an eyebrow at grades as a systemic practice, distinct from simply "not grading." The word is a present participle, an ongoing process, not a static set of practices.

Pivot /ˈpivət/
: to turn on or as if on a pivot

If your institution just continued grading during the pandemic, "business as usual," here's what all those grades were measuring:

how well students and teachers "pivoted" to online

whether students had necessary access and support at home

the ability of students to "perform" in a crisis

What all those grades mostly weren't measuring: student learning and/or content knowledge.

"Deciding to ungrade has to come from somewhere, has to do more than ring a bell, it has to have pedagogical purpose, and to be part of a larger picture of how and why we teach." ~ Sean Michael Morris, "When We Talk About Grades, We Are Talking About People"

Some foundational questions about assessment:

Who is assessment for? How does this question force us to rethink how institutions structure their systems for evaluation?

What's the difference between grading and feedback? To what extent should teachers be readers of student work (as opposed to evaluators)?

Why do we grade? How does it feel to be graded? What do we want grading to do (or not do) in our classes (for students or teachers)?

What would happen if we didn't grade? What would be the benefits? What issues would this raise for students and/or teachers?

"Assessment tends so much to drive and control teaching. Much of what we do in the classroom is determined by the assessment structures we work under." ~ Peter Elbow, "Ranking, Evaluating, and Liking: Sorting Out Three Forms of Judgment"

Ranking. Metrics. Norming. Objectivity. Uniformity. Accreditation. Measurement. Rubrics. Outcomes. Quality. Data. Performance. Averages. Excellence. Curves. Inflation. Mastery. Standardization. Rigor.

I would argue grading, by any of our conventional academic metrics, undermines the work:

Grades are not good incentive.

Grades are not good feedback.

Grades encourage competitiveness over collaboration.

Grades are not good markers of learning.

Grades don't reflect the idiosyncratic, subjective, emotional character of learning.

Grades aren't "fair."

Historically, grades are more of an anomaly than anything else. They are very recent technology.

Prior to the late 1700s, performance and feedback systems in Education were incredibly idiosyncratic. The first "official record" of a grading system was from Yale in 1785. Throughout the 19th Century, they became increasingly comparative, numerical, and standardized.

The A-F system appears to have emerged in 1898 (with the "E" not disappearing until the 1930s) and the 100-point or percentage scale became common in the early 1900s. Letter grades were not widely used until the 1940s. Even by 1971, only 67% of primary and secondary schools in the U.S. were using letter grades. (Schinske and Tanner)

An "objective" system for grading was created so systematized schooling could scale. And we've designed technological tools in the 20th and 21st Centuries that have allowed us to scale further. Toward standardization and away from subjectivity, human relationships, and care.

The grade takes the complexity of human interaction within a learning environment and makes it machine-readable: [A/A-] [A-/B+] [F+] [97%] [59%] [18/20] [10/20] [high first] [low 2:1]

"Research shows three reliable effects when students are graded: They tend to think less deeply, avoid taking risks, and lose interest in learning itself." ~ Alfie Kohn, "The Trouble with Rubrics"

In Pedagogy of the Oppressed, Paulo Freire argues against the banking model of education, "an act of depositing, in which the students are the depositories and the teacher is the depositor."

In place of the banking model, Freire advocates for "problem-posing education," in which a classroom or learning environment becomes a space for asking questions -- a space of cognition not information.

Start by Trusting Students.

A Google search for, "is cheating on the rise?," finds a half-dozen articles like one from The Washington Post, which cites data about the rise of online cheating reported by ProctorU, whose revenue model hinges upon culture of suspicion in education.

In 1963, Bowers surveyed roughly 100 institutions and found that "75 percent of the surveyed students admitted to cheating at least once in their college careers. ... The numbers have not changed much since then." McCabe, et. al.'s 2012 Cheating in College: Why Students Do It and What Educators Can Do About It includes findings from 150,000 students recently surveyed, showing that "between 60 to 70 percent of respondents admitted cheating." (Lang, Cheating Lessons)

The remote proctoring industry "is expected to grow from being a $4 billion market in 2019 to a nearly $21 billion market in 2023." ()

Honorlock, one of these proctoring technologies, markets itself by saying, "Our patented online test proctoring software maintains program integrity while providing extensive learner flexibility." Meanwhile, their patented approach to "ensuring integrity" lacks integrity itself, going further than assuming students cheat by actually baiting them into doing it. They have patented the use of honeypot websites, which offer answers to exams, tracking students accessing these pages and giving them incorrect answers.

Conventional grading is often at odds with our institutional missions. So far, I haven't seen a school mission statement with any of these:

We pit students and teachers against one another

We rank students in competitive ways

We measure output with little concern for the learning process

We value extrinsic over intrinsic motivation

We start from a place of deep suspicion of students

We assess in ways that reinforce bias against marginalized students

Data About Bias in Education (as reported by Soraya Chemaly, "All Teachers Should Be Trained to Overcome Their Hidden Biases"):

Black girls are twelve times more likely than their white counterparts to be suspended.

While Black children make up less than 20% of preschoolers, they make up more than half of out-of-school suspensions.

Teachers spend up to two thirds of their time talking to male students; they also are more likely to interrupt girls. When teachers ask questions they direct their gaze towards boys more often, especially when questions are open-ended.

A meta-analysis from Malouff and Thorsteinsson includes data from 20 studies of 1935 graders finds that "bias can occur in subjective grading when graders are aware of irrelevant information about the students." The authors ultimately suggest "blind grading." But I'd argue race, gender, and ability do not constitute "irrelevant information." We can't counter bias by ignoring it. Who our students are is exactly relevant, and their specific challenges need to be accounted for in our approach to assessment.

"Food insecurity is a significant factor in determining the average math-SAT score. An increase in food insecurity lowers the students' Math-SAT scores." ~ Sharma and Carr, "Food Insecurity and Standardized Test Scores"

Ozturk, et. al. found that students perform more poorly on exams when they are several weeks removed from receiving food-stamp benefits.

"Children displayed a statistically significant increase in cortisol level in anticipation of high-stakes testing. Large decreases and large increases in cortisol were associated with underperformance on the high-stakes test." ~ Heissel, et. al., "Testing, Stress, and Performance: How Students Respond Physiologically to High-Stakes Testing"

Grades are anathema to the presumption of the humanity of students, support for their basic needs, and engaging them as full participants in their own education. Invigilated exams won't ensure integrity. Plagiarism detection tech won't unseat online paper mills. Incessant surveillance won't help us listen better for the voices of students asking for help.

Taking grades at least partly off the table means I have a whole different set of conversations with students I work with. My goal isn't to create a learning environment entirely free of grades (they still get graded in other classes), but to create a safe space for students to ask critical questions about grades, about how school works, and about their own learning.

Ungrading starts with teachers just talking to students about grades. Demystifying grades (and the culture around them) gives students a sense of ownership over their own education.

Minimal Grading: Using scales with fewer gradations to make grading "simpler, fairer, clearer" (Elbow)

Contract Grading: Grading contracts convey expectations about what is required for each potential grade. Students work toward the grade they want to achieve, and goalposts don't unexpectedly shift.

Authentic Assessment: Having students write for real-world audiences, focusing on intrinsic motivations, and drawing students into the design of assignments / assessments.

Process Letters: Asking students to reflect on their work and offer feedback on those reflections. Students help guide the grading of their own work.

Alternative Forms of Assessment:

The statement about assessment from my own syllabi:

This course will focus on qualitative not quantitative assessment, something we'll discuss during the class, both with reference to your own work and the works we're studying. While you will get a final grade at the end of the term, I will not be grading individual assignments, but rather asking questions and making comments that engage your work rather than simply evaluate it. You will also be reflecting carefully on your own work and the work of your peers. The intention here is to help you focus on working in a more organic way, as opposed to working as you think you're expected to. If this process causes more anxiety than it alleviates, see me at any point to confer about your progress in the course to date. If you are worried about your grade, your best strategy should be to join the discussions, do the reading, and complete the assignments. You should consider this course a "busy-work-free zone." If an assignment does not feel productive, we can find ways to modify, remix, or repurpose the instructions.

I've foregone grades on individual assignments for over 20 years. My goal in questioning grades has been to more honestly engage student work rather than simply evaluate it. This practice continues to feel like an act of personal, professional, and political resistance.

While I've experimented with many alternatives to traditional assessment, I have primarily relied on self-assessment. I turn in final grades for the course, but those grades usually match the grades students have given themselves.

My view of students as complex and deeply committed to their education is fueled by the thousands of self-reflection letters I've read throughout my career. What happens with almost every single student is that any assumption I might make about them is squashed by what they write about themselves and their work.

"We need more, not fewer, ways to listen for the voices of students reflecting on education. We need more, not fewer, ways to include students in conversations about the future of teaching and learning in college. These conversations cannot begin by sending a signal to students that their voices don't matter." ~ Sara Goldrick-Rab and Jesse Stommel, "Teaching the Students We Have Not the Students We Wish We Had"

Change how you talk about assessment: Ungrading works best as part of a holistic pedagogical practice. Use words like "ask" or "invite," rather than "submit" or "required." Ask students about their expectations for their work, rather than centering yours.

Invite students to a conversation about grades: Ask students how being graded makes them feel, how it affects their motivation. As a group, read and discuss a piece like Alfie Kohn's "The Case Against Grades."

Grade less stuff, grade less often, grade more simply: Create space in your course for discovery and experimentation. Use a grading scale that feels less arbitrary and communicates more clearly to students. Ask students to do work that you don't "collect."

Ask students to reflect on their own learning: Even if you change nothing else about how you grade, ask students when and how they learn. Ask what barriers they face. Listen. Believe the answers.

Small things you can do tomorrow to start ungrading:

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Ungrading means raising an eyebrow at grades as a systemic practice, distinct from simply "not grading." The word is a present participle, an ongoing process, not a static set of practices.

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Engaged Pedagogy: Theory and Praxis What is Engaged Pedagogy? Engaged pedagogy (a combination of critical and feminist pedgagogies) contends that education is not "neutral"--it does not occur outside social, political, and institutional forms of discrimination. Educational

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Today I'm at Mary Washington College where I'm giving a keynote address at the Digital Pedagogy Lab about a critical condition for learning: basic needs security. It's shame that anyone needs a reminder of the cold hard fact that adequate nutritious food and a good night's sleep are required for learning college material, but let's be honest - there's plenty of evidence that higher education is in the dark. I'm planning to challenge my audience to think about how we support every learner's need for food and housing in an age of harsh and unforgiving inequality and a shredded safety net.

This morning while preparing for my talk I was also working to finish the syllabus for my first class at Temple University. (I didn't teach last year while I was on the road educating policymakers, practitioners, faculty, and students about Paying the Price and launching two federal research studies.) Mine is a course for masters degree students in our higher education program meant to equip them with the skills they need to attend to equity when working on college access and success. We'll be working to unpack concepts such as "college readiness," exploring the dimensions of inequality that shape our students' lives, and discuss actions that practitioners can take when preparing students for college and supporting them while they attend college. Several weeks will be spent discussing the impacts of poverty and systemic racism on college outcomes and ways to use both internal collaborations and strategic external partnerships to ensure that such challenges to contain the harm such things do to the odds that students will complete degrees.

I thought the syllabus was finally finished, having just added the series of requisite College of Education policies (on things like plagiarism, attendance, etc.), when suddenly I realize that something was missing. And then I began crafting a statement on basic needs security, appending it to the set of policies. This was a first for me, but it felt necessary and internally consistent with the course. Here's what it says:
Any student who faces challenges securing their food or housing and believes this may affect their performance in the course is urged to contact the Dean of Students for support. Furthermore, please notify the professor if you are comfortable in doing so. This will enable her to provide any resources that she may possess.
I added those three sentences because acknowledging that all students (including graduate students) face real financial challenges that could affect how they do in class, lets students know that I know this and care a lot about it, and help direct them to both support and resources. At the same time, I am not prepared to field every request and know that the Dean of Students at my university is terrific and her team is ready to help.

Is this the right thing to do? Will it also help accomplish another goal - communicating to my students that a classroom of learners is, in my mind, a sort of family? Is this language exactly right? Will they respond to it as intended? I don't know. But I'm glad I put it there and this afternoon it became the topic of discussion at a Virtually Connecting session during the Lab.

That discussion was revealing. I learned that some of my colleagues aren't allowed to modify their syllabi at all. That ed-tech software is used to examine what they write on their syllabi and ensure "compliance." That the syllabus is apparently more of a legal "contract" (a poor name for it, as my colleagues in the VC pointed out) than a learning tool. Hmmm...

All of that's troubling. But for those of us who can, we should push on. The language we use may need to be tailored to our students. If I were addressing undergraduates, my statement might look more like this:
Any student who has difficulty affording groceries or accessing sufficient food to eat every day, or who lacks a safe and stable place to live, and believes this may affect their performance in the course, is urged to contact the Dean of Students for support. Furthermore, please notify the professor if you are comfortable in doing so. This will enable her to provide any resources that she may possess.
That's even more transparent and specific than what I originally wrote. Maybe it's what I will put on the syllabus for the undergraduate honors course I'm teaching this spring. After all, it's called Paying the Price: Inequality and American Higher Education. It seems appropriate.

PS. I gave the keynote. And had completely forgotten that this syllabus idea was on one of the slides!

PPS. Faculty - after reading this post, please take this quick survey! Thanks.

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Today I'm at Mary Washington College where I'm giving a keynote address at the Digital Pedagogy Lab about a critical condition for learning: basic needs security. It's shame that anyone needs a...

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Like many health and PE teachers, I believe my content areas are vitally important for students. Yet in most schools, students don't attend health education class daily. Some of us see our students every six days, while others teach students for just one semester.

Maximizing all available time with students is critical - which is why it's so important to use strategies that engage students in content and skills. Engagement is the key.

In my health education class, I have established a mindset that "everyone does everything." Yep, that's right. There is no hand-raising. There are no opt outs. My classroom is a "no chill" zone. Everyone. Does. Everything.

Here are 5 of my favorite engagement strategies:

1. Eliminate hand-raising. I bet you thought my #1 strategy was going to be the good ol' pair-share strategy. And to some degree, you are right. For me, cold calling holds everyone's attention. When teachers use hand-raising, typically only those students who think they have the right answer will raise their hand.

And guess what? They are usually right. It tells me they know the information or have an opinion, but it doesn't give me a pulse on the class as a whole.

Calling on students who raise their hands promotes a "chill" zone for other learners. When I only call on students who raise their hand, others can come to my class, sit back, and chill ... without a concern that I'm going to ever call on them for an answer or opinion.

Even though I use cold-calls, I still give students the chance to answer a question correctly or talk out their thoughts before throwing them out to the wolves. I DO use the pair-share strategy. In fact, I love it. It gives each student a chance to think through their thoughts, ideas and answers. But it also gives students a chance to be wrong and change their mind or learn.

Plus, after a pair-share, I KNOW that each student has some sort of an answer, whether it was their original answer or one they discussed with a partner.

2. Stand Up. Hand Up. Give One. Get One. This is probably my favorite strategy for health education class (click here for details) because it allows for several mini-conversations with a variety of different students while moving around the room. And to be honest, it's a bit of a twist on pair-share.

To ensure this strategy is successful I recommend two things: 1) Be relentless in reminding kids to put their hand up to signify they need a partner (If you have a class of 30 like me, it's hard to know who needs a partner if hands aren't in the air.) and 2) Remind students that it's called "Give One, Get One"... not "Give Your Whole List."

I find that if I teach students how to participate in this activity through modeling and guided practice, they catch on quickly and need to be reminded about hand-raising infrequently.

After the activity has concluded, I can go back to cold calling for a large group discussion because I know everyone has a list of many ideas that they can share in a class discussion.

3. Talking Chips. Have you ever had that one student in class who wants to answer every single question? Or wants to give their input on every single topic? Or how about the student who avoids all eye contact, hoping they won't have to talk in front of the whole class? What I love about talking chips is that it puts an end to all these scenarios and creates equity in the conversation.

Talking chips are manipulatives given to students in small group discussions. You can use paper tokens, game pieces, or - my favorite - poker chips. Generally, I give each student two or three chips.

Each time a student wants to speak, they "spend" a chip by placing it in the middle of the group's table. When a student no longer has chips, they must wait to speak until everyone has used their chips. This strategy encourages students to conduct a balanced group discussion by hearing from everyone in the group while ensuring one student does not dominate a discussion.

Again, my room is not a "chill" zone, so everyone is accountable for sharing their thoughts, ideas and opinions.

4. Games: There are many games teachers can play to engage students in health education class, but one quick way to help students master important vocabulary or content-related facts is a deck of "I Have Who Has..." cards. This wrap-around game can be made on virtually any topic and the cards are great for class starters and closers in both small and large groups.

You can find several templates out on the web, but I've attached my own version here.

5. Movement: Nothing engages students in health education class more quickly than asking them to get out of their seats and move around the room. I make it my goal to incorporate some sort of movement activity into each lesson. Sometimes the movement in the classroom complement the learning activity, but other times it can just be as simple as giving the students a chance to stand and stretch.

Here are a few of the educational movement activities and options I use with students:

Four Corners: Not only does this strategy get students away from their desk, it also provides formative feedback for me to gauge understanding. I also add a "turn-and-talk" before discussing the answers with the whole group.

Gallery Walks: This is a discussion technique that allows students to first brainstorm in small groups before bringing the conversation back to the whole class. It gets students out of their chairs and again, gives me formative feedback.

Standing Desks: My classroom has four standing desks that are available to students on a first-come, first-served basis. These desks are usually so popular that my high school students are racing to class to be one of the first four though the door!

Additional Resources

Leah Swedberg

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5 Engagement Strategies for Health Education Class That Really Work - SHAPE America Blog

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Like many health and PE teachers, I believe my content areas are vitally important for students. Yet in most schools, students don't attend health education class daily. Some of us see our students every six days, while others teach students for just one semester.

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Through your syllabus, content, and learning activities, you can engage in inclusive pedagogical strategies at various levels. Consider these ways of approaching your course and activities with inclusivity in mind.

How can I make the learning environment more inclusive?

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Strategies | Inclusive Pedagogy | The University of Chicago

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Through your syllabus, content, and learning activities, you can engage in inclusive pedagogical strategies at various levels. Consider these ways of approaching your course and activities with inclusivity in mind. How can I make the learning environment more inclusive?

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8 Engaging Ways to use Technology in the Classroom to Create Lessons That Aren't Boring

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Are you tired of delivering the same old lectures on the same subjects year after year? Are you using the same lesson materials over and over and wishing you could make learning in your classroom more interactive?

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We asked John Hattie to tell us the story underlying the data of his huge meta study Visible Learning. There is an enhanced role for teachers, because students seek feedback. And feedback works best when you think first of feedback that is received not given. Together with my colleague and co-author Regine Berger we interviewed John Hattie about "Visible Learning". We were especially interested to know how to implement his findings in schools and also how to best train the teachers.
You can also read the Interview in German on www.visiblelearning.de.

Is Visible Learning equally good for all ages?

Which age specific differences should schools consider when implementing visible learning?
John Hattie: I was interested in 4-20 year olds and for every influence was very keen to evaluate any moderators - but found very few indeed. The story underlying the data seems applicable to this age range.

What differences between countries exist when it comes to Visible Learning? How can German schools use the results from your meta study?
A key issue in generalisability is the balance between within- and between-school variance. It seems to me that there is more generalising if there is more within- than between-school variance and thus not sure if Germany fits all in the model. When there is more between-school variance then more structural issues can have a more important role. I note, for example the impressive improvements in your neighbour (Poland) almost simply because they abolished selective nature of their high schools.

"The key to me is the story underlying the data."

What are the milestones to implement the big points of your study?
The key to me is the story underlying the data not the data. Have you see the newer book Visible Learning for Teachers where I spend much more time on this story trying to minimise the data but not ignoring it.

How can teachers learn to give (and receive) feedback in an appropriate and timely manner? How to best train the teachers?
There are two things I have learnt about feedback that are important - first think of feedback that is received not given. And while teachers see feedback as corrections, criticism, comments, and clarifications, for students unless it includes "where to next" information they tend to not use it. Students want feedback just for them, just in time, and just helping nudge forward. So worry more about how students are receiving your feedback much more than increasing how much you give. Also, a third major finding is when teachers receive feedback about their impact then the students are the biggest beneficiaries.

"There is an enhanced role for teachers"

How do you see the future role of teachers? How does it change with visible learning inside?
There is an enhanced role for teachers as students need feedback. They need direction at the surface and deep level. And learning is hard and needs explicit teaching. Learning requires deliberate practice, concentration, persistence and these are taught skills.

What are your experiences with technology (e.g. video) to enable „visible learning"?
I have spent a lot of time on this question. And I think a mistake is thinking about how we add technology to current teaching - but the current teaching barely changes. If we think of it as how we can add face to face teaching to technology the gains are greater - but this is a major change. When I see the latter it is stunning (but rare).

"Start by seeking feedback"

What is your advice to teachers who want to try „visible learning" in their classroom (tomorrow)?
Start by seeking feedback about their impact. Say: "I am an evaluator of my teaching. Who has learnt or not, about what, is it efficient, where to next ..." This is an excellent starting point. And I implore you to read Visible Learning for teachers which elaborate more on this.

Find the books on Amazon: Visible Learning and Visible Learning for Teachers.

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John Hattie: "Think of feedback that is received not given" - VISIBLE LEARNING

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We asked John Hattie to tell us the story underlying the data of his huge meta study Visible Learning. There is an enhanced role for teachers, because students seek feedback. And feedback works best when you think first of feedback that is...Read more ›

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Formative assessment is the lived, daily embodiment of a teacher's desire to refine practice based on a keener understanding of current levels of student performance, undergirded by the teacher's knowledge of possible paths of student development within the discipline and of pedagogies that support such development.
Formative Assessment That Truly Informs Instruction
See the new Formative Assessment That Truly Informs Instruction, written by the NCTE Task Force on Assessment and approved by the NCTE Executive Committee October 21, 2013 (also in a printable booklet format and html Web page format).

Listen as Cathy Fleischer and Scott Filkins, members of the NCTE Task Force on Assessment, talk about formative assessment and this new statement: Part 1 and Part 2.

" A Formative Assessment System for Writing Improvement," " A Better Grading System: Standards-Based, Student-Centered Assessment," and other articles in " Knowing Better: Examining Assessment," the September 2013 English Journal, and " Feed-Forward: Linking Instruction with Assessment," the December 2013 Voices from the Middle.

Hear Kathleen Blake Yancey talk about the response from K-20 educators to the NCTE Assessment Story Project (Education Talk Radio interview, March 4, 2015).

#nctechat Twitter Chat Archive: Formative Assessment That Truly Informs Instruction with NCTE member guest hosts Franki Sibberson (@frankisibberson) and Antero Garcia (@anterobot).

Excerpt from Formative Assessment That Truly Informs Instruction:
Choosing a Formative Assessment Stance
As school decision makers are poised to select new assessments, we urge them to choose a path that supports a formative assessment stance. Teachers deserve protected time and quality support as they learn to observe closely and analyze deeply; students deserve a classroom context that allows teachers to do this. Over time, this professional development raises the quality of teaching and, in turn, the level of student learning. The more teachers can see and understand what students are doing, the better they can support those students in their learning.

Beyond that, decision makers can critically analyze what authentic formative assessment is and is not. Keeping in mind the following chart, teachers and administrators together can choose and create tools and strategies that will truly inform practice, support students, and improve learning.

Highlight the needs of each student

View all students as being, or needing to be, at the same place in their learning

Provide immediately useful feedback to students and teachers

Provide feedback weeks or months after the assessment

Occur as a planned and intentional part of the learning in a classroom

Always occur at the same time for each student

Focus on progress or growth

Focus solely on a number, score, or level

Support goal setting within the classroom curriculum

Occur outside of authentic learning experiences

Answer questions the teacher has about students' learning

Have parameters that limit teacher involvement

Reflect the goals and intentions of the teachers and the students

Look like mini-versions of pre-determined summative assessments

Rely on teacher expertise and interpretation

Rely on outsiders to score and analyze results

Occur in the context of classroom life

Interrupt or intrude upon classroom life

Focus on responsibility and care

Focus on accountability

Inform immediate next steps

Focus on external mandates

Allow teachers and students to better understand the learning process in general and the learning process for these students in particular

Exclude teachers and students from assessing through the whole learning process

Encourage students to assume greater responsibility for monitoring and supporting their own learning.

Exclude students from the assessment process

This position statement may be printed, copied, and disseminated without permission from NCTE.

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Formative Assessment That Truly Informs Instruction

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Formative assessment is the lived, daily embodiment of a teacher's desire to refine practice based on a keener understanding of current levels of student performance, undergirded by the teacher's knowledge of possible paths of student development within the discipline and of pedagogies that support such development.

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Peer Instruction for Active Learning - Eric Mazur

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Watch this video on fostering student connections
(Available only with a UChicago CNET login)

Consider your language

Avoid using phrases such as "It's easy to see..." or "I'm sure you know..." or "It's a no-brainer." These phrases can discourage students who may have questions about the material from asking questions.

Attend to diversity among scholars and content

Not only can including a group of diverse scholars increase belonging among students who typically do not see themselves in scholarship, the incorporation of diverse voices can challenge what students believe regarding who creates knowledge and how. It may also begin to shift the central tenets of traditional disciplines.[1] Ask yourself these questions:

Are there ways in which I can include a wider range of scholars such as women, people of color, and first-generation scholars who address concepts in my discipline? Can I indicate the diversity of scholars by sharing photos of them on my presentation slides?

Can I incorporate any narratives and theories developed by and about people who are typically underrepresented in my area?

Break up lectures and engage students in an activity in order to digest and connect ideas

Delivering lectures in smaller chunks can help students make connections to new ideas, give them time to formulate questions, and help them identify sticking points. When students share notes with classmates, they also have an opportunity to engage with each other and learn from each other's unique perspectives. Consider these techniques:

Pause: Approximately every 15 minutes, pause and give students time to work in pairs to discuss and rework their notes, compare ideas, fill in missing information, and discuss the content with their partners. At the end of each lecture, give students a few minutes to write down the key points they remember, or ask them to write down three key points and the answer to a question and give their paper to you.

Think, pair, share: After posing a sufficiently difficult question, have students think about the question silently for a minute. Then have them pair up and discuss the question with a partner, and then ask the pairs to share their responses with the whole class.

Practice homework problems: After lecturing on a particular type of problem, give students a problem to work on individually in class that resembles the problems they'll see on their homework. After giving students a few minutes to work through the problem, have them compare their strategies and/or answers with a classmate and then with the class.

Lecture transparently

The concept of a lecture may be new to some students. Guide students' listening by making your structure clear. Some things to try include:

Make the structure of the lecture obvious to students with an outline or objectives on an opening slide.

Recap from time to time.

Mark transitions.

Give each slide a unique title.

Don't speak too quickly, allowing students for whom English is a second language time to process new vocabulary.

If a student asks a question in a lecture, repeat it so that everyone else can hear it before giving your reply.

Try not to use unexplained idioms or slang phrases that may confuse students who do not share your frames of reference.

Ensure that students who need to be close to the lecturer (for example, for lip-reading) are seated appropriately. Do not move around the room if students may need to read your lips as you speak.

Use Universal Design for Learning principles to create accessible slides

Consider using Universal Design for Learning (UDL) principles to construct lectures that reach students with various learning needs. The UDL framework advocates for multiple means of representation, expression, and engagement that serve to engage students with varying vision, hearing, and conceptual abilities.

For more information, see Addressing the Challenges of Lecturing from Indiana University.

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Lecture Inclusively | Inclusive Pedagogy | The University of Chicago

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Avoid using phrases such as "It's easy to see..." or "I'm sure you know..." or "It's a no-brainer." These phrases can discourage students who may have questions about the material from asking questions.

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Universal Design for Learning (UDL) is the framework, backed by research, that guides the development of learning environments to accommodate individual learning differences.

Universal Design for Learning recognizes the different needs that are unique to those with visual, hearing, motor, or learning/cognitive disabilities while also designing for able-bodied users as well. UDL provides us, as designers, with guidelines to create an environment that is built for all users to learn, play, and develop together while reducin g limitations.

1. Equitable Use: provides the same means of use for all users with diverse abilities, and design is appealing to everyone

2. Flexibility in Use: design to accommodate a wide range of preferences and abilities

3. Simple & Intuitive: easy to understand and use regardless of the user's experiences, knowledge, language skills, or current concentration level

4. Perceptible Information: communicates necessary info effectively, regardless of surrounding conditions or sensory abilities

5. Tolerance for Error: minimizes hazards and adverse consequences of unintended actions

6. Low Physical Effort: efficient and comfortable while minimizing chance of fatigue

7. Size & Space for Approach & Use: design provides appropriate size and space regardless of the user's body size, posture, or mobility

Some of the most basic ways we design with these seven principles in mind:

Need help making sure your project meets UDL standards? Ask our experts!

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7 Principles of Universal Design for Learning | Schmidt Associates

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Universal Design for Learning (UDL) is the framework, backed by research, that guides the development of learning environments to accommodate individual learning differences. Universal Design for Learning recognizes the different needs that are unique to those with visual, hearing, motor, or learning/cognitive disabilities while also designing for able-bodied users as well.

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Faculty Focus | Higher Ed Teaching & Learning

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Five Essential Strategies to Embrace Culturally Responsive Teaching

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The following practices provide five essential strategies for how educators can make their learning environments more culturally responsive.

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About This Section

This section describes how to plan and design for the variability present in today's postsecondary classrooms. Universal Design for Learning (UDL) is an educational framework that incorporates flexibility into the curriculum from the outset in order to avoid time-consuming retrofitting after the fact. UDL helps faculty members and instructional designers plan their curriculum in ways that reduce barriers to learning and facilitate meaningful participation by all students.

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This section describes how to plan and design for the variability present in today's postsecondary classrooms. Universal Design for Learning (UDL) is an educational framework that incorporates flexibility into the curriculum from the outset in order to avoid time-consuming retrofitting after the fact.

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Pronouns.org Resources on Personal Pronouns

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Depending on the cultural, organizational, and situational context, and the personalities and positionalities of the people interacting, there are many different ways to act if there has been a mistake in referring to someone with the incorrect pronouns. Below are a few example scenarios of ways that people correct themselves or intervene if someone makes a mistake. Please note that these examples focus on times when mistakes are made because of forgetfulness or ignorance -- different strategies may be necessary when people get pronouns wrong because they are being intentionally and consciously hateful.
If you just recently made a mistake:
Example 1. You are talking about someone who goes by "he/him" pronouns. "She is a great student. I'm sorry, I meant to say he is a great student. He's been reading all of the assignments very thoroughly and it's been a pleasure to work with him." You don't have to make a big deal out of your mistake or draw a lot of attention to it. You mostly need to fix it. You might have a follow up conversation with the person you referred to incorrectly to apologize or see if there's something else you can do to correct it moving forward besides doing better. Making it a bigger deal in the moment is not necessarily helpful and could be harmful unless that's what the person who was incorrectly referred to wants. Depending on the situation, you might be worried that people think you aren't friendly towards transgender people because you made a mistake, but generally it's good to avoid making the situation about you and your intent. A good way to show you are friendly is to get it right in the future and to act upon some of the other guidances you may find through this website or other resources.

Example 2. You are talking in a meeting about someone who goes by "they/them" pronouns. "His idea for that project is going to work very well. Let's try that." Later, after the meeting, you realize that you used the incorrect pronouns for that person, so you go to them and say: "I'm really sorry I used the wrong pronouns for you in that meeting earlier. I know you go by 'they/them' and I will make sure I get it right next time." You don't have to linger on the topic if the other person doesn't want to talk about it further, you can simply work to do better.
If you realize you've been referring to someone with either an assumed set of pronouns or pronouns that might no longer be correct:
Example 3. You have a friend who you've always called "she" because you always thought the friend is a woman and goes by "she." You never had a reason to think anything else would be appropriate, but because you've recently learned that making assumptions about pronouns could be problematic, you realize you might want to ask people -- even those who you think are cisgender -- what pronouns they go by. "Hi Tennishia, how are you? ... I recently was learning about personal pronouns and so I've started to tell people that I go by 'she' and 'hers' pronouns myself. It helps me to create an environment where other people can feel comfortable to tell me what pronouns they go by, because some people really aren't comfortable with the pronouns everyone around them assumes work for them. I know we've known each other a long time, and I've always used 'she' and 'hers' pronouns to refer to you, but I realized I might be making some assumptions. Is 'she' and 'hers' okay or should I be using another set of pronouns to refer to you?"

Example 4. You are facilitating a meeting with people who are familiar with each other. "Good morning, everyone. I know that in some of our past meetings we have shared both our names and our personal pronouns, and we've discussed a bit about why pronouns matter. Even though we all know each other already, I thought it would be a good opportunity for us to share again what names and pronouns we are currently going by, just to remind ourselves that these things can change over time, and we want to get it right and make this an inclusive space. Feel free to share whatever you are comfortable with. My name is still 'Dana' and I am still going by 'he' and 'him' pronouns."
If someone else makes what you believe was a mistake:
Example 5. You are talking with an acquaintance about a mutual work friend, Nikhil. Nikhil has told you they only go by "they/them" pronouns. "Oh yeah, Nikhil gave me his book to borrow last weekend." You might respond in a few possible ways. One might be: "Oh? What book did they give you?" This gentle reinforcement could be better than saying "Oh, Nikhil goes by 'they/them' pronouns" for several reasons -- Nikhil might not have discussed that with your acquaintance, and the acquaintance might feel put into a corner or not understand much about pronouns. Depending on the relationships you have, there could be an educational conversation. You might also wonder whether Nikhil is consistently wanting "they/them" pronouns in all contexts or if they are only telling that to certain people. That's why sometimes simply responding to conversations using what you understand to be the correct pronouns can be more helpful than other approaches. Of course, if Nikhil has told you they want you to actively correct other people, go for the educational approach!

Example 6. You are facilitating a workshop in the community with people who mostly don't know each other, although they are friendly and care about diversity and inclusion. You've had a brief discussion about pronouns and included respecting pronouns in your community agreements, and people shared their names and most shared their pronouns at the beginning of the workshop. Later, one workshop participant says "Oh, I really agree with her comment. I also think..." but the person being referred to as "her" actually had earlier said that they go by "they" pronouns. There are many ways you could respond, but one might be speaking to the room: "Maria earlier mentioned they go by 'they' pronouns. I know for a lot of folks in this room these concepts about pronouns may seem new or it's easy to forget them and revert to the assumptions we've been programmed to make, but it's important that we work on this to get it right for folks, just as we'd want to make sure we call people by the right names. I'm happy to chat with anyone during the break who isn't sure how to do this or what it means or anyone who simply wants to practice. Thanks for your affirmation of Maria's comment, Dominique, I agree that they really were on point with that one."

Now that you have some ideas about how to respond when someone makes a mistake, let's talk about how you can share your own personal pronouns.

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What If I Make a Pronouns Mistake? - Pronouns.org Resources on Personal Pronouns

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"Hi! My name is ____ and my pronouns are ____." Pronouns.org offers ample practical resources and information to help you understand personal pronouns, how to share/ask/use pronouns, correct mistakes, and more!

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Pronouns.org Resources on Personal Pronouns

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Usually, the "they/them" pronouns set is acceptable to use when you don't yet know if a person goes by another set or sets of pronouns. You can learn more about the centuries of history behind the singular "they" pronoun to refer to an individual in the resources section. It is also possible to avoid pronouns, as demonstrated below under "no pronouns."

Just because a person goes by a certain set or sets of pronouns is not indicative of that person's gender. A person could be transgender or not transgender (also called "cisgender" - the vast majority of the population is cisgender) and might share the pronouns they go by. A person could be a man or a woman or both or neither and share any number of these sets of pronouns as the correct ones to use for them, but which set they go by is not necessarily indicative of their gender, even though for most people there is an association between the pronouns they go by and the gender they are.

She/Her: " She is a writer and wrote that book herself. Those ideas are hers. I like both her and her ideas."

He/Him: " He is a writer and wrote that book himself. Those ideas are his. I like both him and his ideas."

They/Them: " They are a writer and wrote that book themself. Those ideas are theirs. I like both them and their ideas." Please note that although "they" pronouns here are singular and refer to an individual, the verbs are conjugated the same as with the plural "they" (e.g. "they are"). Also note that in this singular pronoun set many use "themself" rather than "themselves," although both are typically acceptable.

Ze/Hir: " Ze is a writer and wrote that book hirself. Those ideas are hirs. I like both hir and hir ideas." Please note that "ze" is usually pronounced with a long "e" and that "hir" and its forms are usually pronounced like the English word "here." Some people instead go by "ze/zir" pronouns because of the more consistent pronunciation and spelling - see the resources section for more pronouns sets.

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How Do I Use Your Pronouns Correctly? - Pronouns.org Resources on Personal Pronouns

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Usually, the "they/them" pronouns set is acceptable to use when you don't yet know if a person goes by another set or sets of pronouns. You can learn more about the centuries of history behind the singular "they" pronoun to refer to an individual in the resources section.

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In the first class meeting, or the first days of your online course, engaging our students in central themes of the course sends the message that we are excited and eager to help our students learn in this course and that the time they invest in the class matters. This is also a great time to begin building a productive, supportive, and inclusive learning environment. Below are some strategies for making the most of the first class meeting or the start of your online course.

This guide contains the following sections:

Before the Course Begins
Introduce Yourself
Ask Your Students to Introduce Themselves
Introduce the Course
Share the Syllabus
Have Students Communicate with One Another: Icebreakers
Engage Students in Active Learning

Before the Course Begins

A few days before your class begins, consider sending your students an email and posting a News item in your course; briefly introduce yourself and let students know what to expect on the first day of class. If you're teaching online, you can also use this as an opportunity to remind students of the course modality and meeting schedule (if applicable).

Introduce Yourself

An effective introduction helps you establish a welcoming tone and a professional yet approachable presence. Consider how your enthusiasm for the course and discipline can positively impact students' attitudes as well.

In your introduction, consider sharing the following:

What do you love about teaching the course? How long have you been teaching? What is your favorite thing about teaching?

Why did you choose to study and work in your discipline? What do you love about the discipline? How you see the discipline affecting the world and vice versa?

What is your research agenda and how does it relate to the course? (if applicable)

Personal details that you feel comfortable sharing, such as place of birth, family details, hobbies and interests, future plans.

If you're asking students to engage in an icebreaker or diagnostic activity, consider providing your own response to the activity or prompt.

Course Introduction Video

Especially if you're working with your students asynchronously, consider building some of these elements into a pre-recorded course introduction video. Panopto is one tool you can use for recording and sharing that video. In addition to the course introduction elements above, you might also

Explain how your course will be delivered and how students should navigate your D2L course each week

Point out important areas of the D2L course and explain their function in the context of your class (e.g., if you plan to regularly provide students with feedback via Submission folders, show them the ways they can access that feedback)

Emphasize how students can connect with you synchronously, via office hours and any other opportunities for one-on-one meetings or collaboration (e.g., optional group study sessions, individual conferences)

Using video to introduce yourself to students can help students get to know your personality and better perceive your enthusiasm for the course and subject matter.

At the beginning of Spring 2020, the University shared a video that included clips from many instructors' introductory videos. You'll notice that these are nothing fancy: just faculty members speaking into a camera and connecting authentically with students.

Ask Your Students to Introduce Themselves

Before the first class, review your roster to begin learning about your students. On the first day, use some of the time to get to know your students personally and academically.

Learn and Use Students' Names

Learning the names of your students is often cited as a simple way to create an inclusive environment in your classroom. It shows your students you care and helps to foster a sense of community. Furthermore,

researchers have found that knowing student names helps improve student perceptions of instructors and their courses. It's also one way, James Lang argues, to get and hold students' attention.

See 3 Simple Ways to Learn Your Students' Names and Learning Students' Names for practical tips for learning and remembering names.

Collect Information via a First Day Survey

A first day survey is one way to collect information about your students.

Here are some things you might ask students to provide:

Name and pronouns

Context (hours spent working, childcare responsibilities, etc.)

Prior knowledge/experience

Technological proficiency

Personal goals for taking course

First Day or Pre-Course Survey Question Examples

You might begin your survey by asking students to share their name and pronouns. One way to do this is to model:

My name is Abigail Wagner and you can refer to me as Abigail or Professor Wagner. I use she/her/hers pronouns. What is your name and what pronouns do you use?

You might also ask students to share a phonetic spelling or a recording of their name.

Why are you taking this course?

What are your academic and/or professional goals?

What is your greatest academic strength?

What is one thing you hope to do or learn during this course?

What previous experience do you have ______?

What challenges do you anticipate in this course?

What else should I know in order to best support you in this course?

What is your favorite song or musical artist?

What is the best book you've read recently?

What is your favorite movie?

What is your favorite food or meal? Can you share a recipe?

Responses to fun questions can later be used to build community in the class. For example, you might create a playlist of students' favorite songs or compile and share their movie, book, or recipe suggestions.

See a comparison of survey tools available at DePaul to determine the best tool for your first day survey.

Assess Students' Previous Knowledge

It is often beneficial to assess students' previous knowledge and misconceptions about a course topic. This will help us better understand what knowledge students bring to the course and frame our teaching strategies around their needs.

Classroom Assessment Techniques (CATS) are well-suited for gathering this information, (see especially Background Knowledge Probe, Focused Listing, and Concept Maps). " How to Assess Students' Prior Knowledge" from Carnegie Mellon University also addresses how instructors can build on or actively counteract students' assumptions, previous knowledge, and ways of evaluating evidence.

Introduce the Course

Introduce the purpose and application of the course. Presenting it in the context of its discipline, students' lives, and the world at large can help motivate students. You might even consider telling a story to grab their attention. The story could be borrowed from history, could pose an ethical or moral dilemma, or illustrate a vexing problem that your course will address.

Strategies for Introducing Your Course

You could also collect answers to these questions using Poll Everywhere or in a D2L discussion.

Share the Syllabus

A well constructed syllabus shows clear direction, goals, and planning for a course. Provide a digital copy of your syllabus to students before the first class. On the first day, highlight and review key components and important policies. To ensure that students have closely read the syllabus and understand each element, consider having students:

complete a syllabus scavenger hunt, in which students are asked to find specific pieces of information from the syllabus;

work in groups to present different parts of the syllabus to the entire class;

take a low-stakes syllabus quiz (this is often used in online classes);

or work in groups to write 2 or 3 questions about the course that are not covered in the syllabus.

Syllabus Quiz

You can use a syllabus quiz to reinforce important policies and to set clear expectations with students. Some syllabus quiz questions might address things like

Expectations for participation

How to navigate the course and/or prepare for class sessions

How to access and use office hours

Grading and feedback timelines

Late work policies

A syllabus quiz can be facilitated via Poll Everywhere, Zoom polling, and D2L Quizzes. To keep the quiz low-stakes, consider allowing unlimited attempts or collecting anonymous answers. If many students answer a question incorrectly, consider reviewing that information with students.

Syllabus Speed Dating

Syllabus speed dating is one way to introduce your syllabus and encourage students to engage with each other. Maryellen Weimer, writing in Faculty Focus, describes a professor who uses this method; Karen Eifler, an education professor at the University of Portland, designed this activity.

"Two rows of chairs face each other (multiple rows of two can be used in larger classes). Students sit across from each other, each with a copy of the syllabus that they've briefly reviewed. Eifler asks two questions: one about something in the syllabus and one of a more personal nature. The pair has a short period of time to answer both questions. Eifler checks to make sure the syllabus question has been answered correctly. Then students in one of the rows move down one seat and Eifler asks the new pair two different questions. Not only does this activity get students acquainted with each other, it's a great way to get them reading the syllabus and finding out for themselves what they need to know about the course."

Have Students Communicate with One Another: Icebreakers

To begin creating a learning community, students need to communicate with one another. Icebreakers are one way to encourage communication between students. Icebreakers are commonly thought of as just "getting-to-know-you" activities, but they can also serve as a useful inflection point to help your students transition into a learning frame of mind.

Icebreaker Examples

Most of the examples below come from a larger list of 12 icebreakers created by Lansing Community College's Center for Teaching Excellence and The University of Michigan College of Literature, Science, and Arts' list of 3 icebreakers.

Have students complete a form or write on a whiteboard with spaces for "something you already know about the subject," "something you want to learn," and "something that could happen in this class that would make it possible to learn what you need to learn." Have each student introduce themself and share something from the form.

This activity could also be facilitated via Google Docs or Microsoft 365

Break the class into groups of four. Each small group must come up with four things they have in common (all working full-time, all single parents, etc.). Then they are asked to share something unique about themselves individually. The group shares their familiar and unique features with the rest of the class. A master list can be made on the board for the class to look at and discuss if appropriate. (This idea is adapted from Victoria Meyers at Grand Rapids Community College in Michigan.)

This activity could also be facilitated via Zoom breakout rooms or D2L Group Discussions

Give each student a notecard and ask them to write three statements about themselves: one statement should be false, and two should be true. Explain that the goal is to fool people about which one is false. Have each person read their statements and have the group guess the lie.

If you are teaching a large class, you can break students into smaller groups for two truths and a lie activity. Then, after each group has guessed, ask students to introduce their group members to the whole class.

This activity could also be facilitated via Zoom.

Break students into pairs. Ask students to interview their partner. They can start by learning their partner's name, major, and where they're from. Add in other questions and prompts that help students to engage with your subject matter and learn more about their partner. Here are some examples:

If we were to find ourselves in your hometown, what's the one thing you'd say we absolutely had to do before we left?

If you could wake up tomorrow having gained any one quality or ability, what would it be?

What would constitute a "perfect" day for you?

After students interview their partner, they should introduce their partner to another set of partners or to the whole class. This activity helps to encourage good listening skills.

This activity could also be facilitated via Zoom breakout rooms

Ask students to share a recent discovery that has become one of their new favorite things (e.g., a snack, podcast, brand of socks, exercise routine, nature preserve, etc.). Give students time to find a picture or link to help share their new favorite thing with the class.

This activity could be facilitated in small groups and works well in Zoom breakout rooms or D2L Group Discussions.

Icebreakers in Asynchronous Online and Flex Modality Courses

Tools like D2L Discussions, collaborative documents (e.g., Google Docs), and Microsoft Teams can be used to facilitate asynchronous icebreakers. In Flex modality courses, consider providing all students the opportunity to introduce themselves and interact asynchronously before the first synchronous class session. Regardless of the course modality, send emails to acknowledge early participation in icebreaker and community-building exercises and check in with students that haven't yet participated. You might also use the responses to shape the start of a class session, the next module, or to begin a D2L News item that you use to check in with students. For example, you might highlight trends in the responses and indicate how you'll be exploring topics of interest, answering student questions, making time to talk more about the best new show on Netflix, etc.

Incorporate Icebreakers Throughout the Course

Icebreakers are commonly thought of as just "getting-to-know-you" activities, but they can also serve as a useful inflection point to help your students transition into a learning frame of mind. So, you might periodically begin a class session, or a new module or week, with an icebreaker. Polling is a good way to incorporate getting-to-know you activities at the start of synchronous class sessions. D2L Discussions, collaborative documents (e.g., Google Docs), and Microsoft Teams can be used in asynchronous online courses.

Engage Students in Active Learning

In "How to Teach a Good First Day of Class," James Lang emphasizes the importance of asking students to do something on the first day in order to set expectations for participation and to spark learning and enthusiasm. The following strategies are also another way to encourage students to communicate with each other.

Model Future Class Sessions

The first class meeting is a good time to let students know what to expect in terms of the types of activities that they will be doing for the rest of the quarter. One way to do this is to organize a first day activity that models how future class sessions will be conducted. These are some examples of how you might model future class sessions:

Ask students to read a short excerpt of text and analyze or discuss it in small groups

Provide students with a problem and ask them to solve it

Give students a short case study and ask them to map how they would approach it

Facilitate a short lab that helps students to see best practices for using the space

Divide a short poem (or poems) into 5 or 6 parts. Have students form small groups of 5 or 6. Give each student one or two lines from a short poem. Have students read their lines aloud to their group, and then have them reassemble the poem together. The group then discusses and decides on the meaning of the reconstructed poem. (Erickson & Strommer, 1991, p. 90)

Give students 3 minutes to write down the 5 most important historical events or alternatively important people in history. Group students together to create a list of up to 10 "most importants" that they agree on, giving them 10 minutes. Poll each group noting their responses on the board or projector. Determine trends in the list, are the events or people modern if not very recent, are they most American or European, are they primarily political or military. Use the list to guide student reflection about their world views, the limits of those views, and how the course is designed to expand their socio-cultural understandings. (Erickson & Strommer, 1991, p. 90-91)

If you're teaching asynchronously, you can use the first week of your course to model how weeks or modules of your courses will be organized. If you plan to regularly use certain activities, assessments, or assignments, consider asking students to complete a low-stakes version during the first week of the course. As an added bonus, this will give students an opportunity to test out the technology tools.

Ask Students to Think About the Course Metacognitively

Another way to encourage learning on the first day is to ask students to reflect on what they know, what they need to know, and the learning strategies they'll need to be successful in the course. These are some examples of questions you might ask students to reflect on individually or in small groups:

What study, learning, writing, composing, etc. strategies have worked for you in the past? What strategies haven't worked?

What elements and actions contribute to a productive learning environment?

What skills must you learn in order to be successful in this class or in a profession related to this field?

This activity could also be facilitated in Zoom breakout rooms or D2L Group Discussions. See Activities for Metacognition for additional prompts and resources.

References and Further Resources

Bennett, K. (2004). How to start teaching a tough course. College Teaching, 52(3), 106-106.

Case, K., Bartsch, R., McEnery, L., Hall, S., Hermann, A., & Foster, D. (2008). Establishing a comfortable classroom from day one: Student perceptions of the reciprocal interview. College Teaching, 56(4), 210-214.

Erickson, B. L., & Strommer, D. W. (1991). Teaching college freshmen. San Francisco: Jossey-Bass.

Lang, J. (2020). Distracted Minds: 3 Ways to Get Their Attention in Class. The Chronicle of Higher Education.

Lang, J. (2008). On Course: A week-by-week guide to your first semester of college teaching. Cambridge, Massachusetts: Harvard University Press.

Lang, J. (2019). How to Teach a Good First Day of Class. The Chronicle of Higher Education.

" Make the Most of the First Day of Class" from the Carnegie Mellon Eberly Center for Teaching Excellence.

Nilson, L. (2003). Teaching at its best: A research-based resource for college instructors (2nd ed.). Bolton, MA: Anker Publishing.

" The First Day of Class" from Carleton College's Science Education Resource Center.

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​​In the first class meeting, or the first days of your online course, engaging our students in central themes of the course sends the message that we are excited and eager to help our students learn in this course and that the time they invest in the class matters.

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Universal Design for Learning in Higher Education

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Over the past few decades, students, their experiences, upbringings, and backgrounds have changed. Classrooms now reflect families of varying races, cultures, and socioeconomic statuses. As a result, the way teachers educate these students must change, too, says Cherese Childers-McKee, assistant teaching professor in Northeastern University's College of Professional Studies. One of these shifting approaches to education is known as culturally responsive teaching.

Below, we explore the concept of culturally responsive teaching, compare it against traditional teaching models, and offer a number of strategies that you can use to incorporate the approach into your own methods.

Download Our Free Guide to Earning Your EdD

Learn how an EdD can give you the skills to enact organizational change in any industry.

What is culturally responsive teaching?

Culturally responsive teaching, also called culturally relevant teaching, is a pedagogy that recognizes the importance of including students' cultural references in all aspects of learning. Traditional teaching strategies emphasize the teacher-student dynamic: The teacher is the expert and adheres strictly to the curriculum that supports standardized tests while the student receives the knowledge. This teaching method is outdated, Childers-McKee says.

"Teachers have more diverse classrooms today. We don't have students sitting in front of us with the same background or experience, so instruction has to be different," she says. "It needs to build on individual and cultural experiences and their prior knowledge. It needs to be justice-oriented and reflect the social context we're in now. That's what we mean when we talk about culturally responsive teaching."

Culturally Responsive vs. Traditional Teaching Methods

Culturally responsive teaching can manifest in a number of ways. Using traditional teaching methods, educators may default to teaching literature by widely accepted classic authors: William Shakespeare, J.D. Salinger, and Charles Dickens, for example, adhering to widely accepted interpretations of the text.

Culturally responsive teaching, on the other hand, acknowledges that there's nothing wrong with traditional texts, Childers-McKee says, but strives to include literature from other cultures, parts of the world, and by diverse authors. It also focuses on finding a "hook and anchor" to help draw students into the content using their past experiences.

"This way, students can see themselves in some of what they're reading and not just the white, western world. The learning is more experimental, more hands-on," she says. "Instead, you're showing them a worldwide, multicultural community and looking for different interpretations while relating it to what it means for society today."

Why is culturally responsive teaching important?

Culturally responsive teaching is especially pertinent today because the traditional education path from school to college to a career and life in the suburbs isn't a reality-or desire-for everyone, Childers-McKee says. Educators' approaches to teaching need to reflect these differences.

"That typical, mainstream education is not addressing the realities of today's students. Culturally responsive teaching isn't just for those students who don't come from white, middle-class, English-speaking families-it's an important teaching strategy for everyone. When done the right way, it can be transformative."

When integrated into classroom instruction, culturally responsive strategies can have important benefits such as:

Strengthening students' sense of identity

Promoting equity and inclusivity in the classroom

Engaging students in the course material

Supporting critical thinking

Here's a look at five culturally responsive teaching strategies all educators can employ in their classrooms.

5 Culturally Responsive Teaching Strategies for Educators

1. Activate students' prior knowledge.

Students are not blank slates, Childers-McKee says; they enter the classroom with diverse experiences. Teachers should encourage students to draw on their prior knowledge in order to contribute to group discussions, which provides an anchor to learning. Taking a different approach to the literature that's taught in classrooms is one example of this.

2. Make learning contextual.

Tie lessons from the curriculum to the students' social communities to make it more contextual and relevant, Childers-McKee advises. "If you're reading a chapter in history class, for example, discuss why it matters today, in your school, or in your community," she says. "Take the concept you're learning about and create a project that enables them to draw parallels."

3. Encourage students to leverage their cultural capital.

Because not all students come from the same background, it's important to encourage those who don't to have a voice. Say, for example, you teach an English class that contains ESL students. It's important to find ways to activate the experiences they do have-their cultural capital, Childers-McKee says.

The teacher may choose a book for the class to read in which the ESL students could relate and feel like they could be the expert, for instance. As a teacher, Childers-Mckee's once chose a book that told the story of a child of migrant workers because some of her students came from an agricultural background.

"When you have a mixed classroom, you want those in the minority to feel like they are an expert. You want to draw from their experiences," she says. "I do caution that you don't want to cross a line and make 'Johnny' feel like he needs to speak for all Mexican people by putting them on the spot, for example. That's a line you need to walk."

4. Reconsider your classroom setup.

Take inventory of the books in your classroom library: Do they include authors of diverse races? Is the LGBTQ community represented? Do the books include urban families or only suburban families? Beyond your classroom library, consider the posters you display on your walls and your bulletin boards, too. "These are all small changes you can make to your classroom more culturally responsive," Childers-McKee says.

5. Build relationships.

Not all students want to learn from all teachers because the teachers may not make them feel like they're valued, Childers-McKee says. Teachers need to work to build relationships with their students to ensure they feel respected, valued, and seen for who they are. Building those relationships helps them build community within the classroom and with each other, which is extremely important, she says.

"When we think about culture and diversity, people often automatically think about black students, but people need to think broader than that, now," Childers-McKee says. "Some teachers whose students are all white and middle-class struggle with how culturally responsive teaching strategies apply to them. It's equally important for them to teach students about diversity. These aren't just teaching strategies for minorities, they're good teaching strategies for everyone."

Educating for the Future

Educators have the unique power to impact the lives of their learners. Making use of thoughtful, inclusive instruction can have positive effects on students that last far beyond their time in the classroom.

Employing culturally responsive teaching strategies is a small step toward enacting meaningful change in education. If you're interested in leading your organization toward positive change on a larger scale, earning an advanced degree is one way to gain the necessary knowledge and skills to do so.

Pursuing a degree, such as a Doctor of Education , will empower you to address the challenges currently facing education and improve the learning experience. Students of the program work with industry-aligned faculty on real-world organizational issues, allowing them to have an immediate impact on their professional environments.
To learn more about how an EdD can further your career while improving students' educational experiences, explore Northeastern's Doctor of Education program page, or download our free guide below.

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Culturally Responsive Teaching: 5 Strategies for Educators

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Culturally responsive teaching values students' cultural references in all aspects of learning. Here are five strategies to bring to the classroom.

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A popular theory that some people learn better visually or aurally keeps getting debunked.

In the early '90s, a New Zealand man named Neil Fleming decided to sort through something that had puzzled him during his time monitoring classrooms as a school inspector. In the course of watching 9,000 different classes, he noticed that only some teachers were able to reach each and every one of their students. What were they doing differently?

Fleming zeroed in on how it is that people like to be presented information. For example, when asking for directions, do you prefer to be told where to go or to have a map sketched for you?

Today, 16 questions like this comprise the VARK questionnaire that Fleming developed to determine someone's "learning style." VARK, which stands for "visual, aural, read/write, and kinesthetic," sorts students into those who learn best visually, through aural or heard information, through reading, or through "kinesthetic" experiences. ("I learned much later that vark is Dutch for "pig," Fleming wrote later, "and I could not get a website called vark.com because a pet shop in Pennsylvania used it for selling aardvarks-earth pigs!")

He wasn't the first to suggest that people have different "learning styles"-past theories included the reading-less "VAK" and something involving "convergers" and "assimilators"-but VARK became one of the most prominent models out there.

Experts aren't sure how the concept spread, but it might have had something to do with the self-esteem movement of the late '80s and early '90s. Everyone was special-so everyone must have a special learning style too. Teachers told students about it in grade school. "Teachers like to think that they can reach every student, even struggling students, just by tailoring their instruction to match each student's preferred learning format," says Abby Knoll, a Ph.D. student at Central Michigan University who has studied learning styles. (Students, meanwhile, like to blame their scholastic failures on their teacher's failure to align their teaching style with the student's learning style.)

Either way, "by the time we get students at college," says Polly Husmann, a professor at Indiana University, "they've already been told, 'You're a visual learner.' Or aural, or what have you."

The thing is, they're not. Or at least, a lot of evidence suggests that people aren't really one certain kind of learner or another. In a study published last month in the journal Anatomical Sciences Education, Husmann and her colleagues had hundreds of students take the VARK questionnaire to determine what kind of learner they supposedly were. The survey then gave them some study strategies that seem like they would correlate with that learning style. Husmann found that not only did students not study in ways that seemed to reflect their learning style, but those who did tailor their studying to suit their style didn't do any better on their tests.

Husmann thinks that the students had fallen into certain study habits, which, once formed, were too hard to break. Students seemed to be interested in their learning styles, but not enough to actually change their studying behavior based on them. And even if they had, it wouldn't have mattered.

"I think as a purely reflective exercise, just to get you thinking about your study habits, [VARK] might have a benefit," Husmann says. "But the way we've been categorizing these learning styles doesn't seem to hold up."

Another study published last year in the British Journal of Psychology found that students who preferred learning visually thought they would remember pictures better, and those who preferred learning verbally thought they'd remember words better. But those preferences had no correlation to which they actually remembered better later on-words or pictures. Essentially, all the "learning style" meant, in this case, was that the subjects liked words or pictures better, not that words or pictures worked better for their memories.

In other words, "there's evidence that people do try to treat tasks in accordance with what they believe to be their learning style, but it doesn't help them," Daniel Willingham, a psychologist at the University of Virginia, told me. In 2015, he reviewed the literature on learning styles and concluded that "learning styles theories have not panned out."

That same year, a Journal of Educational Psychology paper found no relationship between the study subjects' learning-style preference (visual or auditory) and their performance on reading- or listening-comprehension tests. Instead, the visual learners performed best on all kinds of tests. Therefore, the authors concluded, teachers should stop trying to gear some lessons toward "auditory learners." "Educators may actually be doing a disservice to auditory learners by continually accommodating their auditory learning style," the researchers wrote, "rather than focusing on strengthening their visual word skills."

In our conversation, Willingham brought up another study, published in 2009, in which people who said that they liked to think visually or verbally really did try to think that way: Self-proclaimed visualizers tried to create an image, and self-proclaimed verbalizers tried to form words. But, there was a rub, he said: "If you're a visualizer and I give you pictures, you don't remember pictures any better than anyone who says they're a verbalizer."

This doesn't mean everyone is equally good at every skill, of course. Really, Willingham said, people have different abilities, not styles. Some people read better than others; some people hear worse than others. But most of the tasks that we encounter are really suited to only one type of learning. You can't visualize a perfect French accent, for example.

The VARK questionnaire itself illustrates this problem pretty well. One question, for example, asks:

You are planning a vacation for a group. You want some feedback from them about the plan. You would:

describe some of the highlights they will experience.

use a map to show them the places.

give them a copy of the printed itinerary.

phone, text, or email them.

But of course, any friend-having human in 2018 would email their friends to coordinate group travel, whether or not that email includes the first three elements. (Another question asks, sweetly, "You are helping someone who wants to go to the airport" and suggests different ways of giving directions, along with the option to simply "go with her." It depends on the "her" in question, one would assume!)

The "learning styles" idea has snowballed- as late as 2014, more than 90 percent of teachers in various countries believed it. The concept is intuitively appealing, promising to reveal secret brain processes with just a few questions. Strangely, most research on learning styles starts out with a positive portrayal of the theory-before showing it doesn't work.

Willingham goes so far as to say that people should stop thinking of themselves as visual, verbal, or some other kind of learner. "It's not like anything terrible is going to happen to you [if you do buy into learning styles]," he said, but there's not any benefit to it, either. "Everyone is able to think in words; everyone is able to think in mental images. It's much better to think of everyone having a toolbox of ways to think, and think to yourself, which tool is best?"

Husmann says that the most important thing, for anyone looking to learn something new, is to really focus on the material-that's what the most successful students from her study did. Rather than, say, plopping some flash cards in your lap ... "but I'm really watching the football game," she says.

Fleming did not return a request for comment by press time, but his own papers seem to warn against getting too carried away by VARK. "I sometimes believe that students and teachers invest more belief in VARK than it warrants," he wrote in 2006. "You can like something, but be good at it or not good at it ... VARK tells you about how you like to communicate. It tells you nothing about the quality of that communication."

In other words, it might help you learn about yourself, but it might not help you learn.

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A popular theory that some people learn better visually or aurally keeps getting debunked.

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When a student struggles in the classroom, questions usually focus on the student: Does she have a learning disability? Is this student's reading skill not on par with the other children in the class? Does he not pay enough attention when sitting in class or doing homework? Until recently, there has been comparatively little focus on the role of the curriculum in these struggles. Thanks to work by Harvard Graduate School of Education Lecturer David Rose, the chief education officer of the Center for Applied Special Technology (CAST), researchers and educators alike are now examining how the curriculum, not the student, may be disabled, and how curriculum disabilities can be overcome.

The idea of curriculum disability arose when Rose was working with other neuropsychologists at the North Shore Children's Hospital (near Boston) to evaluate children who were performing poorly in school. Rose and his colleagues often felt discouraged, because their recommendations offered teachers little practical guidance to help their students. Eventually Rose formed a group to see what might make the reports more useful - leading to the creation of CAST.

UDL is the recognition that a standardized learning environment is no longer productive; it is vital - and, with today's technology, possible - to acknowledge differences among students.

CAST researchers gradually realized that the core issue was frequently not students' learning problems; instead, the problem lay with the curriculum. Instead of fixing the students, time would be better spent fixing the curriculum. This insight sparked a new goal: eliminating barriers in the design of the learning environment. To fix the problem, Rose proposed the idea of a Universal Design for Learning (UDL), which promotes supporting every child in the classroom.

Defining principles of Universal Design

To implement this goal of UDL, CAST has defined and adopted three main principles:

1. Multiple means of representation, to give learners various ways of acquiring information and knowledge.

2. Multiple means of expression, to provide learners alternatives for demonstrating what they know.

3. Multiple means of engagement, to tap into learners' interests, offer appropriate challenges, and increase motivation.

These UDL principles are applicable to every student in the classroom, according to Rose, because there is a fundamental mismatch between today's student population and the curriculum: While diversity is now the norm of classrooms across the country, the curriculum remains standardized. The uniformity of the school environment - a leftover factory system from the Industrial Revolution - means that students all receive standardized textbooks, learn from standardized course plans, and sit at standardized desks, despite individual differences. UDL is the recognition that this kind of environment is no longer a productive one; it is vital - and, with today's technology, possible - to acknowledge the differences among students.

Research by Rose and others has uncovered three key insights that explain why multiple representations are essential in the classroom. First, developmental studies have revealed the unmistakable diversity in our nervous systems; that is, the nervous system "wires up" differently for each person. Second, a person's nervous system does not approach all learning tasks in the same way; rather, it assesses the task and how much experience the individual has had with the task, and adjusts its resources and strategies accordingly. There is no single style of learning, even for the same person; students' levels of expertise on different problems will influence how they tackle each one. Finally, research has demonstrated the importance of emotion to learning. The nervous system can easily gauge how valuable a certain experience may be, and the differences in students' responses to a lesson depend on varying levels of motivation. In short, everyone is different, and that means a standardized school system will only work for some - perhaps only for a few.

Using technology to support access and ability

Operating under the principles of UDL, Rose and his CAST colleagues have created a variety of technology programs designed to bolster students' abilities and motivation. CAST products assist students by embedding content in varying ways, and by enabling parents and teachers to create new, customized learning materials.

WiggleWorks, for example, produced and distributed by Scholastic, is a software program that contains children's books with many built-in tools and activities to support the reading and writing process. Book Builder, available online, allows teachers and parents to design story books with similar kinds of supports.

Although technology is undoubtedly a useful tool in the classroom, Rose emphasizes, it is not essential to carrying out UDL principles. UDL refers primarily to how information should be represented in the classroom. For instance, there are many ways to understand Shakespeare: teachers can lecture about the Bard's plays, have students read the plays on their own, ask students to read scenes aloud to the whole class, or help the class put together a performance. The key question that a teacher following UDL principles should ask is: How do I present this information so that kids will really understand, and learn how to show me what they have understood?
Additional information about Universal Design for Learning, including guiding principles and a self-checklist for curriculum developers, is available on the CAST website.

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The Importance of Universal Design for Learning

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When a student struggles in the classroom, questions usually focus on the student: Does she have a learning disability? Is this student's reading skill not on par with the other children in the class? Does he not pay enough attention when sitting in class or doing homework?

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Teachers of middle and high school students know that these learners sometimes require pointed critical feedback on academic assignments to shape their learning. The reason that most instructors put substantial effort into providing often-detailed performance feedback is clear: to benefit the student. But many students-particularly those at risk of academic underperformance or failure-may instead misinterpret critical instructional feedback as a sign that the teacher lacks confidence in and is negatively biased toward the learner.

A factor that can contribute to students' negatively skewed view of instructional feedback is that it is often ambiguous, presented without an explicit context for understanding the intention behind it. This ambiguity leaves learners free to impose their own interpretations-for example, regarding a teacher's written or verbal feedback about an assignment as a sign either of caring and commitment or a curt dismissal of the student's abilities (Yeager et al., 2013). And, in fact, there is evidence that a tendency to construe teacher feedback in a negative light is more common among those students already sensitive to being stereotyped because of social characteristics such as race, gender, or economic class (Cohen, Steele, & Ross, 1999; Yeager et al., 2013). An African-American student, for example, might interpret a White teacher's written feedback on how to improve her research-paper draft as picky, unfair, and driven by racial bias rather than as representing a genuine desire to help the learner advance her writing skills. As a result, the student fails to heed and apply that adult feedback.

Wise Feedback: Supplying a Proactive, Empowering Explanation. Teachers can reduce the tendency of at-risk students to discount evaluative statements as biased by formatting those statements as 'wise' feedback (Cohen, Steele, & Ross, 1999; Yeager et al., 2013). The teacher structures written or verbal feedback to include these 3 elements:

Feedback description. The teacher describes the nature of the feedback being offered.

High standards. The teacher emphasizes and explains the high standards used to evaluate the student work and generate the instructional feedback.

Assurance of student ability. The teacher states explicitly that the student has the skills necessary to successfully meet those standards.

The wise-feedback strategy appears deceptively simple but is powerful in application. Wise feedback prevents the student from misconstruing teacher comments as negatively biased by proactively offering an alternative, positive explanation: the teacher is giving detailed, ambitious feedback because the standards of the course are high and the teacher is confident that the student has the skills and motivation to meet them.

Wise Feedback: Examples. Here are 3 examples of teacher critical feedback formatted as 'wise' feedback:

Wise Feedback: Example 1: Research Paper with Written Feedback

Wise Feedback: Example 2: PowerPoint Presentation with Oral Feedback

Wise Feedback: Example 3: Opinion Survey with Written Feedback

Wise Feedback: Additional Considerations. Like all teacher communication tools, wise feedback has constraints attached to its use:

Do not pair grades with wise feedback. When possible, teachers should avoid attaching grades to any student work that contains wise feedback. Students tend to view a summative number or letter grade as the 'real' evaluation of an assignment and are therefore likely to ignore comments that accompany them (Yeager et al., 2013). So grades can 'short-circuit' the positive impact of wise feedback. The reality, however, is that the assignment of grades is usually unavoidable in course work. One strategy to keep wise-feedback and grading separate on an assignment is to return the first draft of the assignment ungraded with wise feedback. The student is then directed to use the feedback to revise the assignment and submit for a grade.

Make student feedback 'ambitious'. In an attempt to bond with unmotivated students, the teacher may commit the errors of over-praising them for mediocre work or providing only easy suggestions for improving the assignment. Either strategy sets a low bar for performance and can backfire. When students sense that instructors have limited expectations of them, they can feel patronized and stereotyped, lose motivation, and further withdraw effort from academic tasks (Yeager et al., 2013). Instead, the teacher should praise work that truly deserves it and offer thoughtful critical feedback that, relative to students' current abilities, taxes them to stretch and expand their skills in a meaningful way.

Use wise feedback with large groups. Although wise feedback is an excellent tool to communicate teacher expectations to individual students, it is just as powerful (and much more efficient) when communicating with the entire class. For example, before handing back graded math tests containing detailed critical feedback, a middle-school math teacher prepares the class, saying:
(High standards) "By grade 7, students are expected to have fully mastered the many math concepts and operations taught in the earlier grades."(Feedback description) "When you look over this diagnostic math test that you took last week, you will see that I have written a number of comments highlighting where you made errors or failed to show or explain your work."(Assurance of student ability) "Judging by past work that I have seen from each of you, I can see that you all have the skills to be strong math students. My comments will point you to where you should put additional effort to ensure success in this course."

References

Cohen, G. L., Steele, C. M., and Ross, L. D. (1999). The mentor's dilemma: Providing critical feedback across the racial divide. Personality and Social Psychology Bulletin, 25(10), 1302-1318.

Yeager, D. S., Purdie-Vaughns, V., Garcia, J., Apfel, N., Brzustoski, P., Master, A., Hessert, W. T., & Williams, M. E. (2013). Breaking the cycle of mistrust: Wise interventions to provide critical feedback across the racial divide. Journal of Experimental Psychology: General, 143, 804-824.

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How to Help Students Accept Constructive Criticism: 'Wise' Feedback

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Teachers of middle and high school students know that these learners sometimes require pointed critical feedback on academic assignments to shape their learning. The reason that most instructors put substantial effort into providing often-detailed performance feedback is clear: to benefit the student.

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Despite the significant number of people living with disability across the U.S. -and the world at large-widespread misconceptions about disability can cause ableist language and behavior to proliferate.

But what is ableism, and how does it play out in the workplace? Here, we offer some answers to these questions, and insights on how to be more inclusive.

What is ableism?

Ableism is the discrimination, prejudice, or oppression of anyone living with mental or physical disabilities. The underlying premise of ableism is that disabled people are inferior to their more able-bodied or able-minded counterparts.

Some examples include: assumptions that disabled people need or want to be "fixed;" violations of the American with Disabilities Act; inaccessible building design and signage; inaccessible website design; and mockery.

Am I being ableist?

The sneaky thing about ableism is that you may not even realize that you are doing it. Because ableist language has been normalized -including words like "blind," "deaf," "dumb," "idiot," "insane," "lame," "nuts," and "psycho"-it can be difficult to recognize if you are in any way contributing to an oppressive narrative.

However, the best place to start is by being more mindful about the language you use. If you are negatively using descriptors of a disability to describe someone who doesn't have that disability, that is a clear red flag to stop and think of a more appropriate word to use.

Examples of ableism in the workplace

Most people today understand that ableism is a form of discrimination, but they may not be able to spot their own ableist language or actions in a professional setting. Here are some examples of what ableism can look like in the workplace:

Believing you know how a co-worker's disability affects them without asking. Let's say you watched a documentary about a disability also shared by your co-worker. Though that may make you more informed, it doesn't make you an expert on that disability's total effect on a person's life.

Assuming your co-worker is faking their disability.For example, you may notice that a co-worker sometimes leaves early for health reasons, despite not being obviously ill. Keep in mind that not all disabilities are visible. Just because you are unable to see it doesn't mean that it doesn't exist or that it isn't debilitating.

Pretending disability doesn't exist. A co-worker's disability may make you uncomfortable enough that you gloss over it completely. Though it's important to not treat anyone as lesser than because of their disability, it's equally important to acknowledge that they face different challenges. Failing to do this can negate a person's experience.

Comparing your co-worker's disability with your temporary injury or illness. The keyword here is "temporary." For example, if your co-worker's disability affects a body part you've injured in the past, those two experiences are not comparable. Generally speaking, disabilities are long-term and have serious effects on a person's physical and psychological health.

Speaking for your disabled co-worker. If you notice that someone is "talking down" to a co-worker with a disability, don't assume the co-worker wants you to step in. No one likes when someone speaks for them without their permission, so be wary of doing this.

Not making it safe to speak about disability. If disability makes you uncomfortable, or if you hold some assumptions about individuals with a disability, you may be sharing that attitude unintentionally by glossing over or completely neglecting a co-worker's disability. The consequence of this is making it unsafe for your co-worker to speak up and ask for what they need to do their job well.

Learning to be more inclusive

A practical way to eliminate ableism in the workplace is to recognize how you can be more inclusive. Inclusion is not just a set of organizational policies to make sure all employees are safely seen and heard; it is also about doing the homework of reversing your own misconceptions about disability.

By normalizing disability, you can start to reverse any misconceptions (conscious or unconscious) you may have. This means understanding that there are many more people living with disability than you realize, and working to catch yourself before saying or doing something unintentionally ableist.

For instance, many of the examples above have to do with assumptions. To halt your assumptions and make sure you are being sensitive to co-worker with a disability, don't be afraid to ask thoughtful questions. This can start simply with, " How's work going?" and may eventually graduate on to, " What do you need to do your best at work?" or " What is the most challenging part of your experience at work? "

Notice that neither question puts your co-worker's disability front-and-center, and that's the point. Remember that disability is a part of their identity, but it isn't their whole identity. Let them decide if they feel comfortable opening up to you.

***

For more information on how to confront ableism and support your differently-abled friends and co-workers, be sure to check out the Idealist Guide to Working (and Living) with Chronic Illness and Disability.

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What is Ableism? | Confronting Ableism in the Workplace

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Despite the significant number of people living with disability across the U.S. -and the world at large-widespread misconceptions about disability can cause ableist language and behavior to proliferate. But what is ableism, and how does it play out in the workplace? Here, we offer some answers to these questions, and insights on how to be more inclusive.

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So much of our everyday language excludes different backgrounds, genders, and abilities. While this is oftentimes unconscious and unintentional, some commonly used words and phrases can read as male- or cisgendered-centric, while others can reinforce negative stereotypes about mental health, physical ability, or nontraditional family structures.

It's time for our workplaces to embrace a new, more inclusive way to communicate to and about one another. Read on to learn how to promote inclusive communication at work.

What is inclusive language?

The language we use can (unintentionally) leave out entire groups of people. For example, career-related language is often male-gendered, with words like "congressman" or "policeman" commonly used to describe people employed in those professions. Even seemingly innocuous phrases like "mom and dad" can pose difficulties as they fail to acknowledge that many households do not have two opposite-sex parents. Inclusive language seeks to avoid words and phrases that exclude specific groups of people.

"Using gender-neutral and anti- ableist language isn't about just being politically correct," says Sayume Romero, a speech pathology student and LGBTQ activist. "It's about allowing yourself to broaden your perspective. Language is powerful and ... doesn't only affect the listener, but also the user. By taking the extra energy to be more mindful of the language we use, we're training new circuits in our brains and becoming more aware of how certain language can create a more supportive work environment."

Pronouns and gender inclusion

When we speak, we tend to use pronouns like "she" and "he" as generic descriptors. However, there are people who may identify neither as male or female, so it's important that our language takes them into account.

Instead of using traditional binary pronouns, you can use plural gender-neutral pronouns like "they," "them," "their," "theirs," and "themselves." For instance, if you wanted to refer to someone's work, regardless of the fact that they may look male or female, you could say, "They ran a thoughtful social media campaign for that nonprofit's new program." Since you're already familiar with these pronouns, it's not a stretch to start using them instead of gender binary ones.

There are alternative gender-neutral pronouns you can use that look and feel like a new language, but don't be overwhelmed: you don't have to use these identifiers unless you're asked to.

One of the easiest things you can do to incorporate more inclusive language at work is to learn what pronouns your co-workers identify with. Depending on where you work and with a little bit of courage, you can make others-and yourself-feel more included and respected.

You can ask, "Which pronouns do you prefer?" or "How would you like to be addressed?"

If asking feels too forward or potentially offensive, you can take the lead. For instance, "I'm Nisha and I go by she/her." This invites others to do the same.

If you make a mistake and identify someone incorrectly, don't be too hard on yourself; apologize to your co-worker and reaffirm which pronouns they're comfortable with. If you find yourself using gendered, ableist, or heteronormative language, be aware of your mistake and how you could have expressed yourself differently so that you can next time.

Be aware of heteronormative phrasing

Binary gender identity is just one example of heteronormativity, which also includes:

The assumption of heterosexuality;

The assumption of a "mom and dad" family structure; and

Assumptions and references to "traditional" gender roles at home (e.g. "Mom does the dishes while dad brings home the bacon.")

Since the basis of heteronormativity is assumption, the best way to avoid it is to ask inclusive questions when you're unsure of someone's sexuality or preferred gender pronoun. For example, don't ask, "How's your wife?" Instead ask, "How's your partner?"

Unintended ableism

Just as language is gendered, it can also be ableist. Ableism is simply the discrimination against anyone with a physical or mental disability. And our everyday, casual speak can unfortunately be ableist, reinforcing insensitivity and negative stereotypes.

Words like "blind", "deaf," "dumb," "idiot," "insane," "lame," "nuts," and "psycho" are all ableist.

Instead of using words like these, take this opportunity to practice clearer communication. Instead of saying, "My manager is nuts if she thinks we're going to meet that deadline," you can say: "This deadline is unrealistic."

Saying what you mean can prevent the use of offensive shortcuts. For some inspiration, check out the work of some great disability activists.

Promoting inclusion at work

"Ideally using unbiased language will become the norm and standardized, but until then it will take the efforts of organizations and individuals to shift the current language," Romero tells us. But the real key to inclusivity, she says, is being mindful.

"It can seem overwhelming to be mindful of all the possible linguistic pitfalls you may encounter," she notes. "So my first recommendation is to accept that you are human, just like the rest of us. Be open to listening to others and learning from their perspective. If you make a mistake then take the time to understand what it was and learn from it. With time, it will become easier and you too will be able to help others broaden their linguistic perspectives and sensitivities."

***

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A Guide to Inclusive Language in the Workplace

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So much of our everyday language excludes different backgrounds, genders, and abilities. While this is oftentimes unconscious and unintentional, some commonly used words and phrases can read as male- or cisgendered-centric, while others can reinforce negative stereotypes about mental health, physical ability, or nontraditional family structures.

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Edutopia is a free source of information, inspiration, and practical strategies for learning and teaching in preK-12 education. We are published by the George Lucas Educational Foundation, a nonprofit, nonpartisan organization.

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What is Person-Centered Language?

Person-centered language is language that puts people first. People are so much more than their substance use disorder, mental illness, or disability. Using person-centered language is about respecting the dignity, worth, unique qualities and strengths of every individual. A person's identity and self-image are closely linked to the words used to describe them.

Utilizing person-centered language emphasizes the person first rather than the illness. A person-centered approach shifts the sole focus toward their unique recovery and individual strengths. It puts the focus on getting to know the person, not just the illness.

Conversely, when a practitioner uses deficits-based language filtered through a diagnostic label, they may become negatively biased and depersonalize the individual they are working with. Practitioners sometimes use casual labels when describing individuals, such as 'junkie' for an individual with a substance use history or 'cutter' for an individual that engages in self-harm. Typically, practitioners are not intending to demean individual but using this language can become an accepted part of the agency's culture. These narrow and negative labels are stigmatizing and can result in discriminatory and ineffective care.

Below are some examples of deficits-based and strengths-based terms used in treatment settings. Note that person-centered language is constructed with the use of post-modified nouns (e.g. person with a substance use disorder) literally putting the person first in the sentence structure.

Why Person-Centered Language?

Anyone, even helping professionals, may use stigmatizing and deficits-based language unintentionally and thus create an additional barrier toward recovery for the individual. Everyone must make a conscious effort to re-frame situations through person-centered language.

The following examples* highlight the importance of utilizing person-centered language when conceptualizing an individual and describing the individual to colleagues. One example is written from a more traditional perspective and the other written from a person-centered, strengths-based perspective. Be sure to read the note that follows the descriptions.

(This individual prefers the pronouns 'they' and 'their.')

Drew: Drew is an addict that began abusing drugs and alcohol around 12 years old. Drew was manipulative and a real "party animal." The addict hit "rock bottom" and even cut their wrists. The "cutter" was out of control and placed in rehab at age 13. Drew's mother was unfit and so the addict emancipated themselves at age 14 from her and abused the system.

Barry: Barry is a person that has a substance use disorder. Barry is a resourceful and talented actor that began their career at 11 months old. Their mother took them to many parties and Barry was exposed to substances at a young age. After a couple of years, Barry couldn't successfully cope with their substance use disorder and needed treatment, which they received. Barry's mother was experiencing barriers to successful parenting. Barry decided to emancipate themselves at age 14, as that decision seemed to be self-advocating for their best choice for recovery.

Recovery focuses on a person's capacity for change, which means emphasizing an individual's strengths and not just their symptoms.

Strengths-based roles support the recovery process, while negative language emphasizes stigma and promotes isolation.

An important question to consider, "Is naming the disorder pertinent to this conversation with this individual or colleague?" If it is not significant to treatment, then consider leaving it out of the interaction.
*Note: The two descriptions above are of the same individual working toward recovery.
Put yourself in the practitioner role and consider how the different descriptions might influence your perception of the individual and your subsequent interactions and treatment plan. Similarly, what are the implications of this for how the individual comes to think about him/her/their self and their recovery?

The Center for Practice Transformation is sponsored by funds from the Minnesota Department of Human Services Adult Mental Health Division and Alcohol and Drug Abuse Division.

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Person-Centered Language - Center for Practice Transformation

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Person-centered language is language that puts people first. People are so much more than their substance use disorder, mental illness, or disability. Using person-centered language is about respecting the dignity, worth, unique qualities and strengths of every individual. A person's identity and self-image are closely linked to the words used to describe them.

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Abstract

Purpose: The purpose of this study was to measure the change in levels of knowledge of providing culturally competent care and self-assessed cultural competence of senior level dental hygiene students after the implementation of an online cultural competence training module.

Methods: Twenty-eight members of the senior class of 31 dental hygiene students (N=28) volunteered to participate in this IRB approved study at the Ohio State University School of Dentistry. The students took the online Inventory for Assessing the Process of Cultural Competence- Student Version (IAPCC-SV), to assess their self-perceived cultural competence. Upon completion of the pre-test, students then completed the United States Department of Health and Human Services (HHS) Office of Minority Health (OMH) Cultural Competency Program for Oral Health Professionals; a three-module online training program designed to measure increased knowledge of cultural competence. Three weeks following the initial pre-test and upon completion of the Cultural Competency Program for Oral Health Professionals online learning modules, students re-took the IAPCC-SV.

Results: Twenty-eight senior dental hygiene students completed the IAPCC-SV pre-test, the OMH e-learning modules and the IAPCC-SV post-test. The average score on the pre-test was 55.14±7.54 and the average score on the post-test was 61.33±7.86. There was a significant difference in pre-test and post-test scores (p<0.001). There were also significant differences in the constructs of knowledge of cultural competence (p<0.001) and skill (p<0.001).

Conclusion: The HHS OMH Cultural Competency Program for Oral Health Professionals was effective for increasing dental hygiene students' levels of knowledge of cultural competence.

Introduction

According to the 2010 United States (US) census, the US continues to be more culturally diverse which subsequently creates an increasingly diverse population of patients for oral healthcare providers. In order to treat, counsel and communicate with diverse patient populations, oral healthcare providers must be culturally competent. As oral healthcare providers, dental hygiene students must have knowledge, understanding and appreciation for a wide variety of cultures, beliefs and customs in order to provide quality oral care for diverse populations.

Dental hygiene, according to the US Bureau of Labor and Statistics, is one of the fastest growing professions in the US and the number of dental hygienists is projected to increase by approximately 38% between the years 2010-2020. In spite of this projected growth of the profession within an increasingly diverse general population, demographics on the current workforce indicate that dental hygiene is the least culturally diverse of all healthcare providers. According to data from the U.S. Department of Health and Human Services, 85% of dental hygienists are Caucasian and 97.2% are female; leaving the profession severely lacking in diversity. If this lack of diversity continues, the profession may be ill-prepared to treat patients of differing cultures. A more culturally diverse dental hygiene workforce has the potential of being both beneficial to the profession as well as the increasingly diverse population at large. While increasing the cultural diversity of the workforce may be part of a solution, promoting cultural competence within the dental hygiene workforce is essential. Failure to develop culturally competent oral healthcare providers may compromise the quality of and access to care, limit patient resources, threaten patient safety and perpetuate oral health disparities.

Methods

This study used a pre-test, post-test design with a prospective cohort. Participants were recruited from the 31 senior dental hygiene students at Ohio State University, School of Dentistry. The study received an exempt status from the University's Institutional Review Board. The students attended an informational session explaining the study. Following the informational session, students were invited to participate and informed consent was obtained from 28 out of 31 of the senior dental hygiene students. Students took the Inventory for Assessing the Process of Cultural Competency among Health Professionals-Student Version (IAPCC-SV), a 20-item, copyrighted, fee-based, survey instrument as a pre-test. The IAPCC-SV as developed by Campinha-Bacote is specifically designed to assess students' perceived cultural competence levels in five specific areas or constructs: Cultural Awareness, Cultural Knowledge, Cultural Skill, Cultural Encounter and Cultural Desire. Specific questions on the survey are related to each construct. The validity and reliability of this instrument has been established previously in the literature.

The IAPCC-SV is designed so that specific questions are designed to assess the level of each of the specific constructs. Each response is given a point value. For questions 1-13 and 15-20 the values are as follows: strongly agree=4 Points, agree=3 Points, disagree=2 Points, strongly disagree=1 Point. Question 14 uses a reverse coding system and the point values are as follows: strongly disagree=4 Points, disagree=3 points, agree=2 Points, strongly agree=1 Point. Once a number value has been assessed for a student's responses, a level of cultural competence can be established. Culturally proficient is defined as a total score of 75-80, culturally competent 60-74, culturally aware 41-59 and culturally incompetent 20-40. The pre-test survey established a baseline level of knowledge and a level of cultural competence for each student.

Upon completion of the pre-test, students were instructed to complete the US Department of Health and Human Services (HHS) Office of Minority Health (OMH) Cultural Competency Program for Oral Health Professionals. Students were given two full weeks to complete the online training modules. Following the completion of the three modules and post-test, students received an email from the Office of Minority Health Cultural Competency Program confirming completion of the three-course program. To verify completion of the online training modules, the students sent their course confirmation email to the program director. Three weeks following the pre-test, the students completed the IAPCC-SV post-test survey, which was used to establish the level of knowledge of cultural competence following the completion of the HHS OMH online modules. Data was analyzed using JMP 10 (SAS Institute, Cary, NC). The IAPCC-SV pre-test and post-test results were analyzed using descriptive statistics, a paired t-test and Wilcoxon Signed-rank test.

Results

Twenty-eight(N=28) out of 31 senior dental hygiene students agreed to participate in the study. Individual demographic information was not asked of each participant but the class as a whole from which the sample was drawn had a mean age of 22 years with a range of 20-49 years. Ninety percent of the class was female and 87% of the class was Caucasian. Ninety-four percent of the class were domestic students (US citizens) and 6% indicated international citizenship. Twenty-eight surveys were dis-tributed and completed for both the pre-test and the post-test. One participant's survey was missing a response on both the pre-test and the post-post. Therefore, for the specific constructs of Cultural Encounters and Cultural Knowledge, only 27 surveys were utilized.

The average score on the pre-test was 55.41(±7.54) while the average score on the post-test was 61.33(± 7.86) ( Table I). No students fell into the culturally incompetent category on either the pre-test or the post-test ( Table II).

The mean change in overall score from pre-test to post-test was 5.79. Two students had post-test scores that were lower than pre-test scores, but both stayed within the same level of cultural competency from pre-test to post-test despite the lower scores. There were also two students who scored equally on the pre- and post-tests. The greatest overall score increase was 17 points. Scores were also evaluated by construct ( Table I).

After assessing normality of the data, the paired t-test and the Wilcoxon signed rank tests were used to determine if there were differences in the level of knowledge of cultural competence before and after the modules were completed. There was a statistically significant difference in the pre-test to post-test scores in the constructs of knowledge (p<0.001), skill (p<0.001) and overall sum (p<0.001) ( Table III).

Discussion

According to the results from the IAPCC-SV survey, the pre-test results indicated that the majority of the senior dental hygiene students started at the self-perceived level of being culturally aware. After completing the online HHS OMH training modules and then taking the post-test the students increased their self-perceived levels of cultural competency on the IAPCC-SV survey, with the majority of the students at the scoring level of culturally competent. One students score was rated at the highest level of cultural competency: culturally proficient.

The dental hygiene students' mean score for the pre-test was 55.14, which falls within the level of culturally aware according to the scaling of the IAPCC-SV. This finding was not surprising as senior dental hygiene students have received some instruction in cultural competence at various points in the curriculum and have likely experienced interactions with patients from different cultural backgrounds than their own.

In a study by Hawala-Druy et al, health professions students including nursing, pharmacy and allied health were enrolled in an interdisciplinary course designed to provide the necessary knowledge and skills through transformative learning experiences to provide culturally appropriate team-based patient care to diverse populations. Student's levels of cultural awareness, competency and proficiency were measured with the IAPSS-SV both prior to and following the educational intervention. Additional evaluation measures included course evaluations, student feedback and portfolio reflections. Results from the pre and post IAPSS-SV surveys indicated a significant increase in the mean scores from the pre-test mean of 60.8 to the post test mean of 70.6. While Hawala-Druy et al and this study both used the IAPSS-SV instrument and demonstrated an increase in the mean scores of cultural competence, the change in the scores for the dental hygiene students was 5.79 as compared to a change of 10.8 points with health professions students. It is important to note that the single intervention for the dental hygiene students was the online HHS OMH training program administered over a two-week time period while the Hawala-Druy et al studied the effects of a semester-long, interprofessional education course.

In this study, the constructs of knowledge and skill showed the most significant increases in the comparison of the IAPSS-SV pre- and post-test mean scores, 0.496 and 0.560 respectively. Significant increases in these categories may be due to the focus of the HHS OMH online training modules on increasing the knowledge and skills of cultural competency with videos, information along with ways to communicate to achieve culturally and linguistically appropriate oral health care and services (CLAS).

Additional studies cite the challenges of measuring cultural competency within the curriculum. Palombaro et al used the IAPSS-SV to measure the development of cultural competence in physical therapy students over a three-year curriculum with students participating in both mandatory and voluntary experiential learning opportunities that included experiences in a student-run pro bono clinic. Required didactic classroom presentations and activities were also integrated throughout the curriculum. Palombaro et al found that there was an overall improvement in self-assessed cultural competence as a result of a combination of curricular activities with a special emphasis on service learning and cultural encounters. These findings support the construct that the cultural encounters provide that foundation for each individual healthcare provider's journey towards cultural competence.

Measuring and comparing cultural competence, even when similar instruments are used can be challenging. Studies conducted on the curricular integration and measurement of the development of cultural competency in physical therapy students do not differentiate between the various constructs and the changes in the pre- and post-test scores for each construct. Only the overall mean change is examined and reported. This limits the ability to compare previous study results with this study.

Limitations to this study include the sample was only comprised of 28 senior level dental hygiene students at one institution. This was a small, homogenous group and it is difficult to generalize the results as applicable to all dental hygiene programs. This study should be repeated in other dental hygiene programs to further validate the tool in improving cultural competence in the dental hygiene student population.

This pre-test, post-test design within one cohort of students did not allow for a control group. It is unclear whether the HHS OMH training modules or if time, experiences or other external factors over the two-week period influenced the levels of change in cultural competence. Future work should include a control group that does not complete the HHS OMH modules. While some cultural competency studies have tracked the longitudinal effects of specific interventions, this study only looked at the measurement of cultural competence changes over a two-week period of time. Tracking the students' levels of cultural competence over longer periods of time may show how the levels change with ongoing training and experience.

Another limitation was that there was no way to measure the amount of time the students spent on the HHS OMS website. The students were instructed to work on the online training modules independently outside of the classroom and submitted an email indicating completion of the training modules. If the students did not work through the information completely and just completed the post-test at the end of each module, the full impact of the training modules may not have been reflected in their overall scores. Using the training modules within the context of a course would help to ensure more complete participation in all aspects of the modules.

The authors of this study recognize that cultural competence is a multi-faceted construct and one online training program is not adequate to meet the needs of a very diverse patient population. Clinical and community experiences that students have throughout their curriculum also contribute to their levels of cultural competence and patient feedback and health outcomes are critical components of culturally competent oral health care. This study aimed to examine one novel program's effects and it is not suggested that this be the sole content for cultural competence in the dental hygiene curriculum. The HHS OMH training modules can serve as an ideal starting point for the topic are an excellent resource for dental and allied dental educators to address cultural competence in an oral health context.

Future research would include a larger, more diverse sample size, a control group and the ability to track the amount of time spent on the training modules possibly by incorporating the training modules into the dental hygiene curriculum.

Conclusion

Culturally competent dental hygiene care is becoming increasingly more important as the population of the United States becomes more diverse. Dental hygiene accreditation (CODA) standards required that students recognize cultural influences that impact the delivery of healthcare. This study examined the effects of knowledge acquired via the online HHS OMH Cultural Competency Program for Oral Health Professionals as compared to pre- and post-tests of self-perceived levels of cultural competence as measured by the Inventory for Assessing the Process of Cultural Competency among Health Professionals-Student Version (IAPCC-SV). While this single HHS OMH training program and IAPCC-SV student post-tests do not serve as sole indicators of cultural competency, the results of this study demonstrate that the HHS OMH Cultural Competency Program for Oral Health Professionals was effective for increasing dental hygiene students' levels of knowledge of cultural competence.

Footnotes

Heather N. Daugherty, RDH, BSDH is the EFDA Clinical Coordinator and clinical dental hygiene instructor; Dental Hygiene Clinical instructor; Rachel C. Kearney RDH, MS is an assistant professor and chair; both in the Division of Dental Hygiene, The Ohio State University College of Dentistry, Columbus, OH.

This manuscript supports the NDHRA priority area Professional development: Education (educational models).

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Measuring the Impact of Cultural Competence Training for Dental Hygiene Students

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Purpose: The purpose of this study was to measure the change in levels of knowledge of providing culturally competent care and self-assessed cultural competence of senior level dental hygiene students after the implementation of an online cultural competence training module.

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The role of cultural awareness in optimizing the relationship between dental professionals and patients

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How dental hygienists can optimize communication and build positive relationships with patients of all cultural backgrounds.

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PURCHASE COURSE
This course was published in the January 2018 issue and expires January 2021. The authors have no commercial conflicts of interest to disclose. This 2 credit hour self-study activity is electronically mediated.

EDUCATIONAL OBJECTIVES

After reading this course, the participant should be able to:

1. Discuss the growth in diversity in the United States.

2. Explain the importance of cultural competency.

3. Identify strategies for effective patient-provider communication.

4. List oral health problems experienced by marginalized populations.

5. Discuss the role of health literacy in oral health outcomes.

Dental hygienists practice in a variety of settings-private practice, public health, academia, and research to name a few. As essential members of the oral health care team, dental hygienists may provide treatment to people of various cultural backgrounds and belief systems. As such, they must strive to attain cultural competency by forming an active and trusting relationship with patients, which enables the provision of a more comprehensive and all-inclusive care.

The United States has experienced a significant increase in diverse populations over the past several decades and these numbers will likely continue to rise. For example, Hispanics are the largest ethnic minority in the US. In 2014, Hispanics made up 17.4% (55.4 million) of the population and this percentage is expected to increase to 28.6% (119 million) by 2060. ¹The exact numbers vary (Figure 1). ²The US lesbian, gay, bisexual, transgender, queer (LGBTQ) population encompasses approximately 9 million people. ³Roughly 4.1% of Americans identify as gay, lesbian, bisexual, or transgender. ³ As the diversity of the US increases, so must the knowledge of how to treat patients of various backgrounds, social realms, and belief systems. Oral health professionals need to be culturally competent to assess, diagnose, plan, and implement treatment according to individual patient needs.

Diversity involves a variety of factors, not just race and ethnicity. Sexual orientation, sex, age, socioeconomic status, religion, and health literacy are important to consider in the effort to provide culturally competent care. As the patient assessment and treatment plans are completed, all aspects of the individual must be considered. This may require asking personal questions. To be comfortable with diverse populations and delivering culturally competent care, oral health professionals must first learn to overcome the feeling of being uncomfortable. This can be accomplished through exposure to other cultures and learning to accept differences.

BUILDING CULTURAL COMPETENCY

Understanding diverse cultures is the first step in providing optimal patient care. Culture can be described as a set of beliefs, values, attitudes, and behaviors that are common within a group. These may be generational, learned patterns of beliefs and behaviors, or created in a current environment due to circumstances or actions of people within a group. Cultural competency may be depicted as a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enable that system, agency, or professionals to work effectively in cross-cultural situations. ⁴ A culturally competent health care provider is able to respond to groups with behaviors and attitudes that facilitate proficient treatment and communication. Another important aspect of cultural competency is cultural sensitivity, which involves making an effort to understand the culture(s) of patient populations. Oral health professionals are not expected to become fluent in multiple languages but rather to be proactive in using tools to enhance communication and understanding of the communities that comprise patient populations.

EFFECTIVE COMMUNICATION

Specific plans should be developed that are linguistically and culturally acceptable to patient needs. When health care providers fail to understand sociocultural differences, the communication and trust between providers and patients may suffer. ⁵ This may lead to feelings of dissatisfaction, frustration, and anger. Furthermore, developing treatment plans and designing health history forms that are more inclusive of the population can enhance trust and help prevent miscommunication.

To provide culturally effective oral health care, a positive and dynamic relationship must be formed between patients and providers. This relationship requires individualized patient treatment-void of microaggressions-that is respectful and responsive to cultural needs. Microaggressions are brief exchanges-made intentionally or unintentionally-that invalidate or hurt a marginalized group through statements or actions. ⁶ Microaggressions are brief daily indignities, which typically result in unintentional insults.

Microaggressions can be categorized as microassaults, microinsults, and microinvalidations (Figure 2). Microassaults are typically conscious, verbal, or nonverbal behaviors, whereas microinsults are unconscious actions or statements that demean a person's identity. Much like a microinsult, a microinvalidation is when a person's feelings or thoughts are nullified. ⁷Any of these can result in an environmental microaggression, which is when the insults, assaults, or invalidations manifest in an environmental or systemic level. ⁸For example, a microaggression would be to avoid inviting certain groups to events. An example of a spoken microinsult is "Male dentists are better than female dentists." An example of a microassault is using derogatory slang to describe an individual's race. ⁸ Finally, an example of a microinvalidation is assuming a person of a different race or ethnicity does not understand what is being said and has less than average intelligence.

Microaggressions encompass several forms such as race, social class, sexual orientation, etc. In a study of the health-care experience of American Indians, 36% of the participants described undergoing some type of microaggression by a health care provider. ⁹Research suggests that microaggressions harmfully affect the mental health of marginalized social groups, causing depression, low self-esteem, and other mental health problems. ⁷ Although the task of fairly treating patients is the goal of all team members, working with patients who differ in race, culture, socioeconomic status, literacy level, and sexual orientation may pose some challenges.

The ability to communicate with patients is one of the first steps to delivering culturally competent oral health care. Humans use many modes to communicate. Body language, including facial expressions, are integral to human communication. The ability of oral health professionals to effectively relay messages to patients is of the utmost importance. In some cases, patients may appear to have understood directions but may be too embarrassed to confirm their understanding. Patients with limited English proficiency and low health literacy will greatly benefit from alternative forms of communication, such as the teach-back method and the LEARN (listen, explain, acknowledge, recommend, negotiate) model. Both methods are based on clinician-to-patient communication skills, which enable the patient to partake in the learning and treatment planning process.

Involving the patient in the learning process via the teach-back method may increase the effectiveness of patient education (Table 1). This method is an effective way to check how well the patient understood the information provided. ¹⁰It involves asking patients to restate information that has been presented. ¹¹Using the teach-back method enables oral health professionals to check for lapses in the recall of information. ¹¹Any discrepancies in the restatement can then be assessed for comprehension problems, and the provider can explain any misinterpretations. If a patient has a low comprehension level due to language or literacy issues, then the information may need to be repeated and evaluated several times before true comprehension is attained. The teach-back method should be used on a regular basis when providing oral hygiene instructions but is even more critical when bridging the communication gap with patients who speak a different language or have low literacy. Results of a study on hospitalized patients with heart failure who were educated using the teach-back method found that 84% answered 75% of the questions correctly. ¹¹

The LEARN model assists clinicians in improving communication, increasing cultural awareness, and gaining more acceptance of treatment. ¹²The method focuses on listening with sympathy and understanding the patient's perception of the problem, explaining perceptions, acknowledging and discussing the differences and similarities, recommending treatment, and negotiating agreement. ¹³ For example, when a patient explains his or her perception of pain or treatment preferences, listening to these desires may assist in the acceptance of the treatment plan. Explaining procedures and providing options in terms that patients can understand may increase understanding and elicit compliance. When the patient acknowledges an understanding of treatment options, patient-to-provider trust increases. At this point, the oral health professional can recommend treatment and negotiate the treatment plan with the patient if necessary.

Good communication is important to establish a rapport and trust with the patient. Trust permits the patient to share medical histories more willingly. Patients often ask why oral health professionals ask so many nondental questions and one of those reasons is to determine any potential health disparities. A health disparity is a difference in health due to social, economic, or environmental disadvantages. ¹⁴ As dental hygienists are often the first providers to review patients' health histories, they need to understand what oral health disparities may exist.

ORAL HEALTH PROBLEMS

Pregnant women, children, and older adults often have significant oral health issues. These factors plus race/ethnicity, sociocultural backgrounds, type of employment, education, and insurance status all contribute to disparities. Among pregnant women, those enrolled in Medicaid were 24% to 53% less likely to seek oral health care than those with private insurance. ¹⁵Nearly 75% of caries in children ages 6 to 18 occurred in just 33% of the population, including African Americans, Mexican-Americans, American Indians/Alaskan Natives, and low-income groups. ¹⁵The rate for sealant application were 33% lower in African Americans and Mexican Americans than in whites. ¹⁵Among older adults, untreated caries was significantly higher in Hispanics (41%) and African-Americans (37%) than in whites (16%). The same is true for periodontal diseases, with 17% of older Hispanics affected, 24% of African-Americans, and 9% of whites. ¹⁵ Evidence shows a significant disparity in oral health care among nonwhite and low-income populations.

IMPROVING HEALTH LITERACY

There appears to be a relationship between health disparities and low health literacy. ¹⁴Health literacy is the functional ability to read, understand, and act on health information. ¹⁶ Populations with low income levels and low education levels are at increased risk for low health literacy and health disparities.

According to the US Department of Education and National Institute of Literacy, 14% of the US population cannot read and 21% read below a 5th grade level. ¹⁷A National Adult Literacy Study found that 21% to 31% of adults surveyed could not understand an appointment slip and 40% to 74% could not understand a general consent form. ¹⁶

Adults with low health literacy may have difficulty reading insurance forms and completing health histories but they may be too embarrassed to ask for clarification. Low compliance with treatment and oral hygiene education could be an indication of low health literacy. Patients with low health literacy will likely not self-identify so oral health professionals must be able to recognize the signs, such as taking medications incorrectly or asking a family member to read forms aloud. ¹⁶Literacy statistics indicate the factors that contribute to the highest level of low literacy is age (those older than 65), poverty, incarceration, immigration status, race, and lack of education (less than a high school diploma). ¹⁶ Oral health professionals have an ethical obligation to assure that patients understand treatment plans, health histories, dental disease prognosis, and self-care instructions.

HEALTH DATA COLLECTION

Health histories can be confusing or off-putting. Those used in the dental setting should be up to date on correct verbiage, inclusive, and easy to complete. According to the National Institutes of Health, appropriate racial categories are: American Indian or Alaska Native, Asian, black or African American, Native Hawaiian or other Pacific Islander, and white. ¹⁸Ethnicity can be described as Hispanic or Latino, which is an individual with cultural origins from Cuba, Mexico, Puerto Rico, Central or South America, or any other Spanish-speaking culture. ¹⁸Asking patients about race and ethnicity is more comfortable for most people than asking about sexual orientation. Health histories need to list (for insurance and billing reasons) the patient's given birth name, but patients should also be asked how they would like to be addressed. Another aspect of an inclusive health histories is to ask patients what sex was assigned at birth in addition to their current gender identity (Table 2 provides an example). ¹⁹

LGBTQ patients may not feel comfortable revealing their sexual orientation to health care providers. ²⁰However, transgender individuals, especially those in transition, should notify care providers due to possible medical issues caused by the transition. ²⁰In the dental practice, patients who have transitioned from male to female may undergo facial feminization surgery and/or take a hormone regimen to initiate the feminization process. ²⁰ Cosmetic procedures, such as veneers and crowns, may be desired by transgender patients to feminize the teeth after facial reconstruction. Oral health professionals must treat this patient population fairly and with sensitivity.

REFERENCES

1. Velasco-Mondragon E, Jimenez A, Palladino-Davis AG, Davis D, Escamilla-Cejudo JA. Hispanic health in the USA: a scoping review of the literature.Public Health Reviews. 2016;37:31.

2. Kaiser Family Foundation. Distribution of U.S. Population by Race/Ethnicity, 2010 and 2050. Available at: kff.org/disparities-policy/slide/distribution-of-u-s-population-by-raceethnicity-2010-and-2050/. Accessed December 20, 2017.

3. Gallup. In US, More Adults Identifying as LGBT. Available at: gallup.com/poll/201731/lgbt-identification-rises.aspx. Accessed December 20, 2017.

4. Ocegueda DR, Van Ness CJ, Hanson CL, Holt LA. Cultural competency in dental hygiene curricula.J Dent Hyg. 2016;90(Suppl3):5-14.

5. The Commonwealth Fund. Cultural Competency in Healthcare: Emerging Frameworks and Practical Approaches. Available at: commonwealthfund.org/ publications/fund-reports/2002/oct/cultural-competence-in-health-care-emerging-frameworks-and-practical-approaches. Accessed December 20, 2017,

6. White AA 3rd, Logghe HJ, Goodenough DA, et al. Self-awareness and cultural identity as an effort to reduce bias in medicine.J Racial Ethn Health Disparities.March 24, 2017. Epub ahead of print.

7. Nadal KL, Whitman CN, Davis LS, Erazo T, Davidoff KC. Microaggressions toward lesbian, gay, bisexual, transgender, queer, and genderqueer people: a review of the literature.J Sex Res.2016;53:488-508.

8. Sue DW, Capodilupo CM, Torino GC. Racial microaggressions in everyday life: implications for clinical practice.Am Psychol.2007;62:271-286.

9. Walls M, Gonzalez J, Gladney T, Onello E. Unconscious biases: microagressions in american indian healthcare.J Am Board Fam Med.2015;28:231-239.

10. Ping X. Using teach back for patient education and self-management.American Nursing Today.2012;7:3.

11. White M, Garbez R, Carroll M, Brinker E, Howei-Esquivel J. Is "teach-back" associated with knowledge retention and hospital readmission in hospitalized heart failure patients?J Cardiovasc Nurs. 2013;28:137-146.

12. Rose PR. Cultural Competency for the Health Professional. Burlington, Massachusetts: Jones and Bartlett Learning LLC; 2013.

13. Berlin EA, Fowkes WC Jr. A teaching framework for cross-cultural health care. Application in family practice.West J Med. 1983;139:934-938.

14. Mantwill S, Monestel-Umaña S, Schulz PJ. The relationship between health literacy and health disparities: a systematic review.PLoS One. 2015;10:e0145455.

15. Fisher-Owens S, Barker JC, Adams S, et al. Giving policy some teeth: routes to reducing disparities in oral health.Health Aff (Millwood). 2008;27:404-412.

16. Hartsell Z. Health care illiteracy: implications for providers.JAAPA. 2005;18:41-47.

17. Crum M. The US illiteracy rate hasn't changed in 10 years. Available at: huffingtonpost.com/ 2013/ 09/06/illiteracy-rate_n_3880355.html. Accessed December 20, 2017,

18. National Institues of Health. Racial and Ethnic Categories and Definitions for NIH Diversity Programs and for Other Reporting Purposes. Available at: grants.nih.gov/grants/guide/notice-files/NOT-OD-15-089.html. Accessed December 20, 2017.

19. The Fenway Institute and Center for American Progress. Asking Patients About Sexual Orientation and Gender Identity in Clinical Settings. Available at: thefenwayinstitute.org/wpcontent/uploads/ COM228_SOGI_CHARN_WhitePaper.pdf. Accessed December 20, 2017.

20. Koch A. Treating the Transgender Patient: a Personal Narrative. Presented at American Dental Education Association Annual Session; March 19, 2017; Long Beach, California.

From Dimensions of Dental Hygiene.January 2018;16(01):40-43.

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Cultivating Cultural Competency in the Dental Setting

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Dimensions of Dental Hygiene is a monthly, peer-reviewed journal that reconnects practicing dental hygienists with the nation's leading educators and researchers. Dimensions is committed to the highest standards of professionalism, accuracy, and integrity in our mission of education supporting oral health professionals and those allied with the dental industry.

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For decades, researchers have found that teachers in public schools have undervalued the potential for academic success among students of color, setting low expectations for them and thinking of cultural differences as barriers rather than assets to learning.

In response, scholars developed teaching methods and practices-broadly known as asset-based pedagogies-that incorporate students' cultural identities and lived experiences into the classroom as tools for effective instruction. The terms for these approaches to teaching vary, from culturally responsive teaching and culturally sustaining pedagogy to the more foundational culturally relevant pedagogy. Though each term has its own components defined by different researchers over time, all these approaches to teaching center the knowledge of traditionally marginalized communities in classroom instruction. As a result, all students, and in particular students of color, are empowered to become lifelong learners and critical thinkers.

This explainer unpacks what it means to be a culturally responsive teacher, how all these research terms are related, and where other academic concepts such as critical race theory tie in-or not.

What is the definition of culturally responsive teaching?

Culturally responsive teaching means using students' customs, characteristics, experience, and perspectives as tools for better classroom instruction.

The term was coined by researcher Geneva Gay in 2000, who wrote that "when academic knowledge and skills are situated within the lived experiences and frames of reference for students, they are more personally meaningful, have higher interest appeal, and are learned more easily and thoroughly."

It's the kind of teaching that helps students of color see themselves and their communities as belonging in schools and other academic spaces, leading to more engagement and success.

What is culture, and why is it relevant to student learning?

Culture refers to the customs, languages, values, beliefs, and achievements of a group of people. Students' culture and lived experiences that influence how they understand and make sense of the world or themselves are an integral part of who they are as learners. As Emily Style, the former founding co-director of the National SEED Project (Seeking Educational Equity and Diversity), once wrote, "Half the curriculum walks in the door with the students."

While more than half of public school students are students of color, most schools are organized around the mainstream culture of white Americans. The culture that many students experience at home and in their communities is not always represented at school-or is represented in a stereotypical way.

Also, 80 percent of teachers are white. Research has found that teachers are just as likely to have racial biases as non-teachers, and those biases tend to influence the expectations they have for their students and their ways of managing their classrooms. For example, past research has found that white teachers have lower expectations for Black students than they do for white students, and those can turn into "self-fulfilling prophecies" when students internalize them or when teachers change their approach to students as a result of their mindsets.

One study found that white teachers were more likely to praise a poorly written essay if they thought it was written by a student of color than if they thought the essay was by a white student. Teachers' racial biases can also result in decreased access to advanced coursework and higher rates of suspensions.

When did culturally responsive teaching start?

Culturally responsive teaching stems from the framework of culturally relevant pedagogy, which was introduced by scholar Gloria Ladson-Billings in the 1990s. Ladson-Billings was tired of the commonly held narrative that Black children were deficient and deviant, and that there was something wrong with them. Instead, she wanted to find out what was right with Black children, their families, and their communities. To do so, she researched the practices of effective teachers of Black students.

For about two years, Ladson-Billings observed teachers who were identified by both principals and Black parents as being excellent. The teachers had different ways of teaching, but they all had high expectations for their students and fostered academic success. They also all valued and integrated themselves in the community from which their students came.

Ladson-Billings distilled the commonalities in those teachers' beliefs and practices into the framework of culturally relevant pedagogy, which she defined as a model that "not only addresses student achievement but also helps students to accept and affirm their cultural identity while developing critical perspectives that challenge inequities that schools (and other institutions) perpetuate."

There are three components of culturally relevant pedagogy:

student learning-prioritizing students' intellectual growth, including their ability to problem-solve;

cultural competence-creating an environment where students affirm and appreciate their culture of origin while also developing fluency in at least one other culture; and

critical consciousness-teaching students how to identify, analyze, and solve real-world problems, especially those that result in societal inequities against marginalized groups.

So, what are the characteristics of culturally responsive teaching?

Gay's research shows five essential components of culturally responsive teaching:

A strong knowledge base about cultural diversity. Teachers should understand different racial and ethnic groups' cultural values, traditions, and contributions to society, and incorporate that knowledge into their instruction.

Culturally relevant curricula. Teachers should include multiple perspectives in their instruction and make sure the images displayed in classrooms-such as on bulletin boards-represent a wide range of diversity. Teachers should also contextualize issues within race, class, ethnicity, and gender.

High expectations for all students. Teachers should help students achieve academic success while still validating their cultural identities.

An appreciation for different communication styles. Teachers should understand different communication styles and modify classroom interactions accordingly. For example, many communities of color have an active, participatory style of communication. A teacher who doesn't understand this cultural context might think a student is being rude and tell the student to be quiet. The student may then shut down.

The use of multicultural instructional examples. Teachers should connect students' prior knowledge and cultural experiences with new knowledge.

Doesn't that require teachers to reinforce stereotypes about students of color and even discriminate against white children?

In short, no. While the academic framework of culturally responsive teaching and other asset-based pedagogies emerged from how to best support students of color, it evolved into a teaching approach that serves all students, regardless of their racial background.

Sharroky Hollie, the director of the nonprofit Center for Culturally Responsive Teaching and Learning, works with teachers to practice what he calls cultural and linguistic responsiveness. In his work, he talks about the rings of culture, meaning the various aspects of students' identities that can impact how they interact with the world around them.

To Hollie, it's not just about thinking of ways to validate and incorporate a student's racial background into the classroom. It's not about thinking of students in a one-dimensional, stereotypical way. Culturally responsive teachers must also consider the student's gender, age, socio-economic status, whether they live in the suburbs or a rural area, and more.

"It's not as simplistic as we're trying to value our students of color," he said. "We're actually trying to value the rings of culture that they bring to our schools, regardless of their racial background."

For instance, in predominately white school districts, there are white students who, due to where they live or their family's socio-economic status, are underserved by their school district and could benefit from a culturally responsive approach to education, Hollie said.

What is culturally sustaining pedagogy, and how is it different than culturally relevant teaching?

Schools are still places where white norms are considered the default standard in the curricula, behavioral expectations, linguistic practices, and more. Culturally sustaining pedagogy says that students of color should not be expected to adhere to white middle-class norms, but their own cultural ways of being should be explored, honored, and nurtured by educators.

The framework builds on the work of Ladson-Billing and others but offers a "loving critique" that cultural relevance in the curriculum is not enough for students in today's world, given demographic shifts toward a more diverse society. Paris and Alim also argue that asset-based pedagogies, like culturally relevant teaching, traditionally haven't paid enough attention to young people's more fluid relationships with their identities.

Ladson-Billings has embraced the evolution of her foundational pedagogy, writing in 2014 that "culturally sustaining pedagogy uses culturally relevant pedagogy as the place where the beat drops." She also told Education Week that she is now paying close attention to how teenagers shape culture, an aspect that wasn't present in her original work.

It's important to remember that these asset-based pedagogies-culturally responsive, culturally relevant, and culturally sustainable, among others-are not in conflict with each other. While their frameworks vary, they all have the same goal of dismantling a deficit approach to educating students of color and focusing instead on their strengths, assets, and communities in the classroom.

What does the research say about the effectiveness of these teaching frameworks?

A 2016 synthesis of decades of research on culturally responsive teaching and related frameworks found that engaging in culturally affirming practices across subject matters, including mathematics and science, led to positive increases in students' understanding and engagement with academic skills and concepts.  For instance, students in high school math class could learn about statistics by assessing the probabilities of racial profiling cases in various neighborhoods or using other datasets applicable to their communities that bring up questions about justice and injustice.

Culturally responsive teaching and similar approaches to teaching also increased students' motivation, interest in content, and the perception of themselves as capable students, among other benefits, the study found. Brittany Aronson, an associate professor in educational leadership at Miami University in Oxford, Ohio, and a co-author of the study, said, whenever teachers drew direct connections between classroom lessons and students' experiences outside of school, students could see greater value in the academic content as it applies to the real world. Such work helps students see themselves as knowledge producers and researchers.

Overall, teaching that makes school relevant to students helps them succeed both in terms of quantitative measures such as high test scores, and more qualitative measures such as becoming life-long learners able to ask critical questions about the world around them, both in and out of school, Aronson said.

What are some examples of culturally responsive teaching?

Teachers who practice culturally responsive teaching have a classroom full of books featuring characters and images that represent a variety of ages, genders, ethnicities, and other types of diversity. They share the achievements and expertise of people from different ethnic groups in every subject area. They include multiple perspectives when discussing historical and contemporary events, including those from oppressed groups who are often left out of the narrative. And they encourage students to draw on their prior knowledge and cultural experiences to make connections to the academic content.

Culturally responsive teaching also must have an element of critical consciousness, where students are empowered to critique and analyze societal inequities. For example, Teddi Beam-Conroy, an associate teaching professor at the University of Washington, was teaching the Declaration of Independence to a class of 5th graders. When they got to the line that said, "All men are created equal," Beam-Conroy asked her students, "Who were the men who were considered equal at that point?" To illustrate the point, she asked everyone to stand up-and then told them to sit down if they didn't identify as male, if they didn't identify as white, or if their parents rented instead of owned a home.

That exercise opened the door to a conversation about how Americans weren't all equal in the late 18th century. Beam-Conroy's students discussed when women and African Americans got the right to vote-and what implications that has had on the composition of U.S. Congress or the Supreme Court. The critical consciousness piece is "examining how historically, power has been distributed and guarded among particular folks who make the laws," Beam-Conroy said. "Fifth graders can understand that."

Culturally responsive teaching can also involve a deeper reimagining of classroom codes of conduct. For instance, in some students' culture, talking while someone else talks shows how invested and engaged they are in the conversation, said Hollie with the Center for Culturally Responsive Teaching and Learning. Culturally responsive teachers find ways to incorporate that verbal overlap into their lesson rather than seeing it as rude or worthy of discipline.

What isn't culturally responsive teaching?

Researchers note that some educators say they're practicing culturally responsive teaching, but it's an overly simplified version. For example, for some teachers, a multicultural school potluck meal or adding diverse books to their classroom library sufficiently counts as affirming students' culture in education. But culturally responsive teaching is deeper, more critical work.

"There's a tendency to truncate culturally responsive teaching to be about a whole myriad of things-it's about relationships, it's about anti-racist education, it's about diverse books," said Zaretta Hammond, the author of Culturally Responsive Teaching and the Brain. "It's like that old parable of the king who asks nine blind men to describe an elephant. Each one grabs a different part of the elephant. 'Oh, it's flat and wide'-he's got the ear. 'No, it's like a rope'-he's got the tail. No one has the whole picture."

Too often, she said, white progressive educators view culturally responsive teaching as an add-on to their regular instruction instead of a fundamental shift in their pedagogy. For example, a teacher might think students of color just need to see themselves in order to feel motivated and do the work, so she'll incorporate diverse books into her classroom or syllabus-but not change anything to the content or her way of instruction.

Another common misconception is that culturally responsive teaching is a way of addressing student trauma, which is a deficit-based ideology that assumes the universal experience of people of color is one of trauma, Hammond said.

How widespread is culturally responsive teaching?

Most teacher-preparation programs have also incorporated culturally responsive teaching into their courses. And some school districts, including New York City and Baltimore City, have adopted a culturally responsive and/or sustaining approach to education.

Still, experts say it's difficult to pinpoint exactly how many teachers have adopted these asset-based pedagogies because some may use only certain tenets. For instance, helping students develop a critical consciousness is often ignored.

What does all of this have to do with critical race theory?

Critical race theory, broadly speaking, is an academic concept with the core idea that race is a social construct, and racism is not only the product of individual bias or prejudice but is also embedded in policies and systems, such as a legal system-or as some scholars such as Ladson-Billings propose, an educational system.

Aspiring K-12 teachers in graduate level courses may study aspects of critical race theory to better understand how school systems are designed in ways that don't serve the needs of students of color. But critical race theory is not taught as a guide for classroom instruction, nor is it typically used as a culturally relevant or culturally responsive lesson plan for kids and teens, said Aronson with Miami University.

Asset-based pedagogies, like culturally relevant or culturally responsive teaching, are not the same thing as critical race theory. They have different theoretical bases and different goals. However, there might be some commonalities-for example, the questions students are encouraged to ask about social systems, including education, may ring close to the consciousness critical race theory is meant to evoke.

In an interview with Education Week, Ladson-Billings stressed that culturally relevant teaching, as she defined it, has nothing to do with critical race theory. But opponents to critical race theory have glossed over those nuances, she said, adding that deliberative public debate is hard when people don't know what they're talking about.

"The attack on anything that allows more participation and moves us toward equity is going full force," she said.

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Here's what it means to be a culturally responsive teacher and where critical race theory ties in-or not.

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It's more than just seeing patients.

It's helping them understand what dental care is.

It's giving easily understood explanations about dental procedures and making patients feel valued.

Health equity means everyone has a fair and just opportunity to be as healthy as possible. But before a patient ever gets to the dental chair, there are many factors to consider that may be going on behind the scenes.

"The COVID-19 pandemic has underscored the systemic inequalities in our health care system that severely impact populations along racial and geographic lines," ADA President Daniel J. Klemmedson, D.D.S., M.D., said. "Removing barriers to care is essential in ensuring that every community receives access to the quality and affordable health care they deserve."

Barriers to care
In April, the ADA Health Policy Institute published a series of infographics and data looking into racial disparities in oral health. The data also highlighted the dental care utilization among the U.S. population, finding that for all age groups, Hispanics and Blacks are most likely to face cost barriers to dental care.

Patients often face multiple barriers, especially when they are looking for dental care. These barriers can range from struggles with oral health literacy, child care and transportation to problems finding a dentist taking new patients or annual cap limits in Medicaid. Patients who didn't grow up seeing a dentist regularly may be afraid. Some may have lost their insurance after retiring or losing a job.

Nearly 80 million adults and children were enrolled in Medicaid and the Children's Health Insurance Program as of November 2020, according to the Centers for Medicare & Medicaid. That number includes more than 6 million who signed up during the pandemic.

"It's difficult to value oral health and making a dental appointment if you are struggling with food, shelter and housing insecurities," said Jessica Meeske, D.D.S., chair of the ADA Council on Advocacy for Access and Prevention.

Tooth decay remains the most chronic condition for children and adults, and nearly half of all adults over 30 have some form of periodontal disease, according to the Centers for Disease Control and Prevention.

Growing up in rural Nebraska, Dr. Meeske didn't have to look very far to see the importance of health equity. Her mom was a school nurse who always made sure the children in her charge had eyeglasses or dental care regardless of their family income.

"She just found a way without complaint so these kids could see the chalkboard and not be sitting in school with a toothache," she said. "In addition, both my dental school education at the University of Missouri-Kansas City School of Dentistry and pediatric residency training at the University of Iowa College of Dentistry provided me with opportunities to care for patients with Medicaid and instilled in me the importance of dentistry's social contract with society."

In her own dental practice, Dr. Meeske, a pediatric dentist, said she works hard to meet the needs of the Medicaid population in her community, including providing her staff with the education and tools to address every patient's unique problems and concerns by adopting a mindset of compassion and helpfulness.

"I also limit my Medicaid by age or referral by general dentists," she said. "Much of the success is in learning how to listen to parents' concerns and accept the fact that I can only provide the best care I can with the available resources that the family has and that my Medicaid program pays for. I've adopted an attitude that none of the problems and barriers we face in our choice to care for the Medicaid population are unsolvable. It just takes commitment."

Outside the box
In some cases, helping patients get the dental care they need might mean diverting from business as usual.

"So many dentists, we take our time with our patients and that's a great thing," said Brett Kessler, D.D.S., ADA 14th District trustee and liaison to the Council on Advocacy for Access and Prevention. "We'll do a full, comprehensive exam with X-rays and maybe a cleaning on that first appointment but no treatment. If the patient does require follow-up treatment, it means they're going to have to come back. But for some patients, taking time off from work isn't easy."

Sometimes the best gift a dentist can give a patient is to get them out of pain.

"A lot of times people in pain aren't thinking that clearly and they just want to be out of pain. This happens with all patients," Dr. Kessler said. "But before we can do comprehensive care, we have to first get them out of pain. Then we can formulate a plan to stabilize things and have a discussion of what their goals are for their teeth. But those conversations never happen when they're in pain or have an infection."

Of course, there is always the possibility that the patient might never come back, but Dr. Kessler thinks it's worth it to meet them where they are.

"I used to be a dentist who didn't want anyone to dictate my fees and took no insurance," he said. "I created a niche for my practice that brought me happiness but it did nothing for the public. And I thought if patients valued their teeth, they would find ways to make it work."

Making it work took on new meaning after reading a book he felt spoke to him directly: "Bridges Out of Poverty: Strategies for Professionals and Communities."

"It really made me see there is so much more to this," Dr. Kessler said. "How is someone going to pay for dental care if they also need to pay their electric bill or get their kids to school? How are they going to keep their job if they're missing teeth? It really expanded my viewpoint. These patients have to come on Saturdays, they need evening appointments or may have to come with their entire family."

Action for Dental Health
Most adults have tooth decay at some point in their lives and many don't get treatment, but making sure more people have access to things like fluoride mouthwash and other preventive measures was a key observation on oral health conditions in Healthy People 2030 - a 10-year plan from the U.S. Department of Health and Human Services that addresses the nation's most critical public health issues.

The ADA continues to believe that prevention is the ultimate answer to eliminating the vast majority of dental disease.

"We know that prevention works," Dr. Klemmedson said. "Community water fluoridation, sealants, teaching people how to take care of their families' teeth and gums, and getting the greatest possible number of children and adults into dental homes are the keys to better oral health for everyone."

Since 2013, the ADA's Action for Dental Health initiative has worked to prevent dental disease before it starts and to reduce the proportion of adults and children with untreated dental disease. In 2018, the Action for Dental Health Act became law. The Act allows organizations to qualify for oral health grants to support activities that improve oral health education and dental disease prevention. It also helps groups develop and expand outreach programs that facilitate establishing dental homes for children and adults, including the elderly and those who are blind or disabled.

Programs under the Action for Dental Health umbrella include the Emergency Department Referral Program, which features community partnership models to help patients find dental homes so they don't have to go to the emergency department for dental treatment. The ADA's Community Dental Health Coordinator program addresses barriers to oral health by providing patient navigation and addressing barriers such as translation or insurance enrollment for people who typically do not receive care. These barriers are often referred to as the "social determinants of health."

One of the major elements of the CDHC program involves making sure patients have a friendly face associated with a dental office to help them navigate appointment scheduling and sometimes transportation and childcare so they don't have to miss an appointment. CDHCs work in schools, health departments or private practices to help accomplish this. They often live in the same communities they serve, thereby creating a "circle of trust," which is critical to engaging populations into care.

ADA efforts
The ADA is committed to supporting equity in the workforce as well as the public. Earlier this year, the Association held webinars on health equity to educate ADA staff as well as other volunteer leaders. The ADA worked with the National Dental Association and Hispanic Dental Association in presenting the webinars. Both of those organizations, as well as the Society of American Indian Dentists, are part of the Diverse Dental Society, a nonprofit launched in 2020 that "believes in collaborating and assisting its member partners in the pursuit of their institutional missions, in the areas of service, education, leadership and advocacy especially in the underserved arenas."

The ADA Institute for Diversity in Leadership is designed to enhance the leadership skills of dentists who belong to racial, ethnic and/or gender backgrounds who have been traditionally underrepresented in leadership roles. The Institute Class of 2021-22 will convene in Chicago for two-day sessions on the following dates: Dec. 2-3, 2021; Aug. 11-12, 2022; and Dec. 1-2, 2022. There is no fee to apply and participation is open to all active, licensed dentists residing in the U.S. regardless of their ADA membership status. The application deadline is May 31, 2021. Visit the webpage for more information.

The ADA is on the record supporting two bills in the current Congress that address health equity issues. S 54, the Strengthening America's Health Care Readiness Act, calls for additional funding for the National Health Service Corps as well as establishing an NHSC Emergency Service demonstration project. HR 379, the Improving the Social Determinants of Health Act, would create a Social Determinants of Health Program at the Centers for Disease Control and Prevention.

The ADA believes these bills would address existing health workforce shortages and help improve health equity in underserved communities.

"Social determinants such as access to healthy food, good job opportunities, reliable transportation, safe housing and educational opportunity can have a large impact on health, including oral health," Dr. Klemmedson said. "The ADA is proud to support legislation such as this and encouraged to see lawmakers prioritizing the importance of oral health for all."

"When we have this shared vision of oral health equity for all and learn how to transcend barriers, the rewards in the end far outweigh the challenges," Dr. Meeske said

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Health equity means everyone has a fair and just opportunity to be as healthy as possible. But before a patient ever gets to the dental chair, there are many factors to consider that may be going on behind the scenes.

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Even though the assessment and treatment of pain is a universally important health care issue, modern medicine still has no accurate way of measuring it. Patients are often asked to rate their pain on a scale from 1- 10: mild (1-4), moderate (5-6), and severe (7-10). Sometimes smiling and frowning faces are used as visual aids to help both doctor and patient convey what the numbers signify. Cultural differences in response to pain compound the inherent challenges of communication. Although nearly all people experience pain sensations similarly, studies show there are important differences in the way people express their pain and expect others to respond to their discomfort. There are also culturally-based attitudes about using pain medication. An understanding of the impact of culture on the pain experience is important in assuring effective and culturally-sensitive patient care.

Pain Response & Culture

It is well established that pain is a highly complex phenomenon that involves biological, psychological, and social variables.1 Patients' culturally-based responses to pain are often divided into two categories: stoic and emotive. Stoic patients are less expressive of their pain and tend to "grin and bear it." They tend to withdraw socially. Emotive patients are more likely to verbalize their expressions of pain, prefer to have people around and expect others to react to their pain so as to validate their discomfort. We can make the broad generalization that expressive patients often come from Hispanic, Middle Eastern, and Mediterranean backgrounds, while stoic patients often come from Northern European and Asian backgrounds. If we use such broad generalizations to help understand human behavior, however, we must always keep in mind that while culture is a framework that directs human behavior, not everyone in every culture conforms to a set of expected behaviors or beliefs. Rigid use of generalizations leads to cultural stereotyping which in turn can lead to serious inaccuracies. Any individual's experience of pain will manifest itself in emotional and behavioral responses particular to his or her culture, personal history, and unique perceptions.

American Culture & Pain Response

For western health care professionals it is important to understand how our own culture affects the attitudes we may hold about pain. Only through this self-awareness can we establish a basis for comparison that allows us to see where our attitudes and beliefs are likely to collide with those of patients who come
from very different cultures. We are apt to believe that our reaction to pain is "normal" and anything substantially different is "abnormal". For example, a doctor or nurse raised in a family that encouraged stoicism may not know how to react to a patient who responds to pain with loud verbal complaints and may even discount such "overly expressive" reactions. There is a long tradition of stoicism in European American culture; generations of children, especially boys, would be admonished for crying like babies but applauded for keeping a stiff upper lip. In general, people made as little fuss as possible over injuries and illness. Naturally, children socialized in this way will grow up to be "easy patients" who behave in ways consistent with the values of the western medical system. On the other hand, there are cultures where a child's crying immediately elicits the greatest sympathy, concern, and aid. In such cultures, children's' health is fretted over constantly - even a sneeze can be seen as illness. This predisposes children to become more anxious about their health in general, and as adults, they may need greater reassurance from caregivers even in the face of minor symptoms. In general, when people are ill they revert to childhood behavior. If complaining brought them attention as children, they will likely complain out of habit as adults - even if the desired results are not forthcoming from the caregivers around them.

Asian Culture & Stoicism

Patients from Asian cultures may often exemplify stoicism in the face of pain, which relates directly to strong cultural values about self-conduct. Behaving in a dignified manner is considered very important, and a person who is assertive or complains openly is considered to have poor social skills. This behavior might be tolerated in very small children, but not in adolescents and adults. In traditional Asian cultures, preserving harmony in interactions with others is very important, so an individual should never draw attention to himself, especially in negative ways. Though an individual may feel sadness or pain, it is not customary to make this obvious. On a related note, some Asian patients will be socialized to observe status differences between people and will avoid making demands of health care professionals for this reason. Asian societies have traditionally emphasized status differences between people based on variables such as age, sex, education, and occupation. A doctor or nurse will most surely be seen as a person of high status, not to be questioned or bothered with complaints about discomfort.

Putting Pain Into Words

The limitations of language to convey experience - even between people who speak the same language - are extremely obvious when we can't explain something as important as the intensity of pain we feel or the unrelenting worry and frustration pain sometimes causes. To further complicate communications, not all cultures describe pain in the same way. Words such as "sharp," "throbbing," "stabbing," or "aching" make sense to most people in the U.S., but in many tribal cultures stories or symbols are essential in relating one's worldview, so very different words are used to describe pain. Clinicians might be baffled by patients explaining their pain in terms of natural symbols like lightning, trees with deep spreading roots, spider webs, or the tones of drums and flutes.2 In cultures where evil spirits are believed to cause illness and pain, patients may talk about their suffering as punishment. Indeed, some patients will need help in understanding how to talk about pain in ways western doctors and nurses can interpret. Through careful listening and probing health care professionals will uncover what is really happening with each patient's pain. Keep in mind that referencing pain measurement tools that rely on numbers or any kind of linear format, such as a row of faces, won't work equally well across cultures. People in some cultures attach great superstition to particular numbers, and smiling does not suggest feeling good in all cultures. In fact, in some Asian cultures, people tend to smile when they are embarrassed or angry.

Religious and Spiritual Aspects of Pain

In many cultures around the world where belief in fate and karma are strong, people often believe illness and injury are caused by a higher power. In many cases, the acceptance of pain is important in demonstrating a person's religious faith. In one case, a Nigerian refugee to the U. S. suffered a severe knee injury and underwent arthro-miscroscopic surgery. His American nurse waited for him to request pain medication, but he never did. Being Muslim, he offered his pain to Allah in thanks for the good fortune of being allowed the special surgery.3 In a similar case, a Filipino patient hospitalized for shoulder surgery admitted to his nurse that he was in severe pain. However, he wasn't taking his pain medication because he believed it was God's will that he had such pain, and God would give him the strength to bear it.4 A similar stoicism in the face of pain may be common among Buddhists who believe acceptance of suffering leads to spiritual growth. Among some Native Americans, the blessing of medications by a tribal medicine man puts a patient more at peace with the creator which in turn makes the medicine "stronger".

Cultural Perceptions of Pain Treatments

A tendency to discount immediately the sort of cultural practices and beliefs mentioned above can be countered by invoking the placebo effect, which is well-documented. There is also its opposite - the "nocebo effect" where a person who disbelieves in a treatment experiences a worsening of symptoms due to pessimism about getting well. What motivates people's reactions to placebos is interesting in how it parallels different cultural perceptions and expectations around medicines in general. Are shots more effective than pills? Does a bigger pill work better than a smaller one? Is bitter medicine stronger and more effective than medicine that tastes good? Answers to questions like these are indeed often dependent upon cultural background. In some cultures, people believe that the more intrusive a procedure is, the better it is for them. So, an intravenous pain medication would be preferred to narcotic analgesic tablets even if the tablets were highly effective. In some countries, injections are very common; so a Cambodian patient, for example, might believe that without an injection, treatment is inadequate. A Filipino or East Indian patient might reject pain medications altogether out of fear of harmful effects, including addiction. Clearly, it is important to explain the rationale behind use of pain medication to all patients, and to ask patients from different cultural backgrounds which type of medication is preferred in their culture. Also, how do they feel about taking pain medications personally? Since cultural and/or religious reasons may inhibit someone from asking for pain medication, it is often necessary for doctors and nurses to anticipate a patient's pain needs and to initiate important discussions.

Conclusion

Part of understanding our own culturally-based attitudes about pain includes gaining awareness of the things we take for granted. We have come to expect pain management as part of proper treatment in the U.S., but in many countries pain medications aren't readily available or affordable. Or, their use may be stigmatized - as being self-indulgent, addictive, etc. An appreciation of the influence of culture on affective responses to pain and expectations for pain treatment is critical to culturally responsive management of people in pain. The role of the health care provider is to help patients advocate for what feels appropriate for them within their cultural context. r

References
1. Michelle A. Fortier, M.,Cynthia T. Anderson, C. and Kain, Z. Ethnicity Matters in the Assessment and Treatment of Children's Pain PEDIATRICS Vol. 124 No. 1 July 2009, p. 378
2. Burhansstipanov L. Lessons Learned from Native American Cancer Prevention, Control and Supportive Care Projects. Asian American and Pacific Islander Journal of Health. Summer- Autumn 1998: vol. 6. No. 2. pp. 91-99.3,4 Geri-Ann 3,4. Galanti, Caring for Patients from Different Cultures (Philadelphia: University of Philadelphia Press, 1997 p. 35
For more information on this and related topics visit www.dimensionsofculture.com

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Even though the assessment and treatment of pain is a universally important health care issue, modern medicine still has no accurate way of measuring it. Patients are often asked to rate their pain on a scale from 1- 10: mild (1-4), moderate (5-6), and severe (7-10).

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GABRIELLE RAPPOLT-SCHLICTMANN: Learning is really a lifelong journey and when students come to postsecondary

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Equitable Health Care Requires Inclusive Language

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The words that clinicians use with their patients make a difference. They can help or hinder efforts to reduce the disparities in health care. Therefore, it is important for clinicians to strive to use inclusive language and avoid labeling people. To that end, this article offers six principles of i…

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This article covers:

What is Inclusive Pedagogy

Teaching Tools

Supportive Resources

What is Inclusive Pedagogy?

Inclusive Pedagogy is a student-centered approach to teaching that engages the wealth of intersecting social identities and positionalities that all students bring to the classroom. It must not be an afterthought, rather, it should permeate every aspect of curriculum and course design, classroom management, and assessment of teaching and learning (Iturbe-LaGrave, 2018).

Through Inclusive Pedagogy, faculty can reimagine their teaching and dismantle oppressive practices that have hindered the academic success of historically underrepresented students in American Higher Education. It is an approach to teaching that requires us to recognize, assess, and respond to microaggressions; to co-construct knowledge, community agreements, and curricula through which every student's experiences in the world are validated and seen (Iturbe-LaGrave, 2018).

While this module is not an exhaustive nor comprehensive overview, it provides tools to begin pivoting toward this holistic and transformative way of teaching and learning.

Definitions

"[Inclusive] pedagogy requires that educators embrace their students as whole human beings consisting of mind, body, and soul and create interactive and dynamic classroom environments that inspire deep and meaningful transformational learning" (Tuitt et al., 2016, p. 218).

"Inclusive learning and teaching in higher education refers to the ways in which pedagogy, curricula, and assessment are designed to engage students in learning that is meaningful, relevant, and accessible to all. It embraces a view of the individual and individual difference as the source of diversity that can enrich the lives and learning of others" (Hockings, 2010, p.1)

Frameworks

Inclusive Pedagogy (Tuitt, et. al., 2016)

Trauma-Informed Pedagogy (Harris, et. al, 2001)

Culturally Relevant Pedagogy (Ladson-Billings, 1995)

Culturally Sustaining Pedagogies (Paris et. al., 2017)

Funds of Knowledge (Moll, L., Amanti, C., Neff, D., & Gonzalez, N., 1992)

Humanizing Pedagogy (Del Carmen Salazar, 2013)

Intersectional Pedagogy (Case, 2016)

Universal Design for Learning (CAST)

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This article covers: What is Inclusive Pedagogy Teaching Tools Supportive Resources Inclusive Pedagogy is a student-centered approach to teaching that engages the wealth of intersecting social identities and positionalities that all students bring to the classroom. It must not be an afterthought, rather, it should permeate every aspect of curriculum and course design, classroom management, and assessment of teaching and learning (Iturbe-LaGrave, 2018).