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• Published: 06 April 2020

The influence of education on health: an empirical assessment of OECD countries for the period 1995–2015

• Viju Raghupathi 1 &
• Wullianallur Raghupathi 2  

Archives of Public Health volume  78 , Article number:  20 ( 2020 ) Cite this article

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A clear understanding of the macro-level contexts in which education impacts health is integral to improving national health administration and policy. In this research, we use a visual analytic approach to explore the association between education and health over a 20-year period for countries around the world.

Using empirical data from the OECD and the World Bank for 26 OECD countries for the years 1995–2015, we identify patterns/associations between education and health indicators. By incorporating pre- and post-educational attainment indicators, we highlight the dual role of education as both a driver of opportunity as well as of inequality.

Adults with higher educational attainment have better health and lifespans compared to their less-educated peers. We highlight that tertiary education, particularly, is critical in influencing infant mortality, life expectancy, child vaccination, and enrollment rates. In addition, an economy needs to consider potential years of life lost (premature mortality) as a measure of health quality.

Conclusions

We bring to light the health disparities across countries and suggest implications for governments to target educational interventions that can reduce inequalities and improve health. Our country-level findings on NEET (Not in Employment, Education or Training) rates offer implications for economies to address a broad array of vulnerabilities ranging from unemployment, school life expectancy, and labor market discouragement. The health effects of education are at the grass roots-creating better overall self-awareness on personal health and making healthcare more accessible.

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Introduction

Is education generally associated with good health? There is a growing body of research that has been exploring the influence of education on health. Even in highly developed countries like the United States, it has been observed that adults with lower educational attainment suffer from poor health when compared to other populations [ 36 ]. This pattern is attributed to the large health inequalities brought about by education. A clear understanding of the health benefits of education can therefore serve as the key to reducing health disparities and improving the well-being of future populations. Despite the growing attention, research in the education–health area does not offer definitive answers to some critical questions. Part of the reason is the fact that the two phenomena are interlinked through life spans within and across generations of populations [ 36 ], thereby involving a larger social context within which the association is embedded. To some extent, research has also not considered the variances in the education–health relationship through the course of life or across birth cohorts [ 20 ], or if there is causality in the same. There is therefore a growing need for new directions in education–health research.

The avenues through which education affects health are complex and interwoven. For one, at the very outset, the distribution and content of education changes over time [ 20 ]. Second, the relationship between the mediators and health may change over time, as healthcare becomes more expensive and/or industries become either more, or less hazardous. Third, some research has documented that even relative changes in socioeconomic status (SES) can affect health, and thus changes in the distribution of education implies potential changes in the relationship between education and health. The relative index of inequality summarizes the magnitude of SES as a source of inequalities in health [ 11 , 21 , 27 , 29 ]. Fourth, changes in the distribution of health and mortality imply that the paths to poor health may have changed, thereby affecting the association with education.

Research has proposed that the relationship between education and health is attributable to three general classes of mediators: economic; social, psychological, and interpersonal; and behavioral health [ 31 ]. Economic variables such as income and occupation mediate the relationship between education and health by controlling and determining access to acute and preventive medical care [ 1 , 2 , 19 ]. Social, psychological, and interpersonal resources allow people with different levels of education to access coping resources and strategies [ 10 , 34 ], social support [ 5 , 22 ], and problem-solving and cognitive abilities to handle ill-health consequences such as stress [ 16 ]. Healthy behaviors enable educated individuals to recognize symptoms of ill health in a timely manner and seek appropriate medical help [ 14 , 35 ].

While the positive association between education and health has been established, the explanations for this association are not [ 31 ]. People who are well educated experience better health as reflected in the high levels of self-reported health and low levels of morbidity, mortality, and disability. By extension, low educational attainment is associated with self-reported poor health, shorter life expectancy, and shorter survival when sick. Prior research has suggested that the association between education and health is a complicated one, with a range of potential indicators that include (but are not limited to) interrelationships between demographic and family background indicators [ 8 ] - effects of poor health in childhood, greater resources associated with higher levels of education, appreciation of good health behaviors, and access to social networks. Some evidence suggests that education is strongly linked to health determinants such as preventative care [ 9 ]. Education helps promote and sustain healthy lifestyles and positive choices, nurture relationships, and enhance personal, family, and community well-being. However, there are some adverse effects of education too [ 9 ]. Education may result in increased attention to preventive care, which, though beneficial in the long term, raises healthcare costs in the short term. Some studies have found a positive association between education and some forms of illicit drug and alcohol use. Finally, although education is said to be effective for depression, it has been found to have much less substantial impact in general happiness or well-being [ 9 ].

On a universal scale, it has been accepted that several social factors outside the realm of healthcare influence the health outcomes [ 37 ]. The differences in morbidity, mortality and risk factors in research, conducted within and between countries, are impacted by the characteristics of the physical and social environment, and the structural policies that shape them [ 37 ]. Among the developed countries, the United States reflects huge disparities in educational status over the last few decades [ 15 , 24 ]. Life expectancy, while increasing for all others, has decreased among white Americans without a high school diploma - particularly women [ 25 , 26 , 32 ]. The sources of inequality in educational opportunities for American youth include the neighborhood they live in, the color of their skin, the schools they attend, and the financial resources of their families. In addition, the adverse trends in mortality and morbidity brought on by opioids resulting in suicides and overdoses (referred to as deaths of despair) exacerbated the disparities [ 21 ]. Collectively, these trends have brought about large economic and social inequalities in society such that the people with more education are likely to have more health literacy, live longer, experience better health outcomes, practice health promoting behaviors, and obtain timely health checkups [ 21 , 17 ].

Education enables people to develop a broad range of skills and traits (including cognitive and problem-solving abilities, learned effectiveness, and personal control) that predispose them towards improved health outcomes [ 23 ], ultimately contributing to human capital. Over the years, education has paved the way for a country’s financial security, stable employment, and social success [ 3 ]. Countries that adopt policies for the improvement of education also reap the benefits of healthy behavior such as reducing the population rates of smoking and obesity. Reducing health disparities and improving citizen health can be accomplished only through a thorough understanding of the health benefits conferred by education.

There is an iterative relationship between education and health. While poor education is associated with poor health due to income, resources, healthy behaviors, healthy neighborhood, and other socioeconomic factors, poor health, in turn, is associated with educational setbacks and interference with schooling through difficulties with learning disabilities, absenteeism, or cognitive disorders [ 30 ]. Education is therefore considered an important social determinant of health. The influence of national education on health works through a variety of mechanisms. Generally, education shows a relationship with self-rated health, and thus those with the highest education may have the best health [ 30 ]. Also, health-risk behaviors seem to be reduced by higher expenditure into the publicly funded education system [ 18 ], and those with good education are likely to have better knowledge of diseases [ 33 ]. In general, the education–health gradients for individuals have been growing over time [ 38 ].

To inform future education and health policies effectively, one needs to observe and analyze the opportunities that education generates during the early life span of individuals. This necessitates the adoption of some fundamental premises in research. Research must go beyond pure educational attainment and consider the associated effects preceding and succeeding such attainment. Research should consider the variations brought about by the education–health association across place and time, including the drivers that influence such variations [ 36 ].

In the current research, we analyze the association between education and health indicators for various countries using empirical data from reliable sources such as the Organization for Economic Cooperation and Development (OECD) and World Bank. While many studies explore the relationship between education and health at a conceptual level, we deploy an empirical approach in investigating the patterns and relationships between the two sets of indicators. In addition, for the educational indicators, we not only incorporate the level of educational attainment, but also look at the potential socioeconomic benefits, such as enrollment rates (in each sector of educational level) and school life expectancy (at each educational level). We investigate the influences of educational indicators on national health indicators of infant mortality, child vaccinations, life expectancy at birth, premature mortality arising from lack of educational attainment, employment and training, and the level of national health expenditure. Our research question is:

What are some key influencers/drivers in the education-health relationship at a country level?

The current study is important because policy makers have an increasing concern on national health issues and on policies that support it. The effect of education is at the root level—creating better overall self-awareness on personal health and making healthcare more accessible. The paper is organized as follows: Section 2 discusses the background for the research. Section 3 discusses the research method; Section 4 offers the analysis and results; Section 5 provides a synthesis of the results and offers an integrated discussion; Section 6 contains the scope and limitations of the research; Section 7 offers conclusions with implications and directions for future research.

Research has traditionally drawn from three broad theoretical perspectives in conceptualizing the relationship between education and health. The majority of research over the past two decades has been grounded in the Fundamental Cause Theory (FCT) [ 28 ], which posits that factors such as education are fundamental social causes of health inequalities because they determine access to resources (such as income, safe neighborhoods, or healthier lifestyles) that can assist in protecting or enhancing health [ 36 ]. Some of the key social resources that contribute to socioeconomic status include education (knowledge), money, power, prestige, and social connections. As some of these undergo change, they will be associated with differentials in the health status of the population [ 12 ].

Education has also been conceptualized using the Human Capital Theory (HCT) that views it as a return on investment in the form of increased productivity [ 4 ]. Education improves knowledge, skills, reasoning, effectiveness, and a broad range of other abilities that can be applied to improving health. The third approach - the signaling or credentialing perspective [ 6 ] - is adopted to address the large discontinuities in health at 12 and 16 years of schooling, which are typically associated with the receipt of a high school diploma and a college degree, respectively. This perspective considers the earned credentials of a person as a potential source that warrants social and economic returns. All these theoretical perspectives postulate a strong association between education and health and identify mechanisms through which education influences health. While the HCT proposes the mechanisms as embodied skills and abilities, FCT emphasizes the dynamism and flexibility of mechanisms, and the credentialing perspective proposes educational attainment through social responses. It needs to be stated, however, that all these approaches focus on education solely in terms of attainment, without emphasizing other institutional factors such as quality or type of education that may independently influence health. Additionally, while these approaches highlight the individual factors (individual attainment, attainment effects, and mechanisms), they do not give much emphasis to the social context in which education and health processes are embedded.

In the current research while we acknowledge the tenets of these theoretical perspectives, we incorporate the social mechanisms in education such as level of education, skills and abilities brought about by enrollment, school life expectancy, and the potential loss brought about by premature mortality. In this manner, we highlight the relevance of the social context in which the education and health domains are situated. We also study the dynamism of the mechanisms over countries and over time and incorporate the influences that precede and succeed educational attainment.

We analyze country level education and health data from the OECD and World Bank for a period of 21 years (1995–2015). Our variables include the education indicators of adult education level; enrollment rates at various educational levels; NEET (Not in Employment, Education or Training) rates; school life expectancy; and the health indicators of infant mortality, child vaccination rates, deaths from cancer, life expectancy at birth, potential years of life lost and smoking rates (Table 1 ). The data was processed using the tools of Tableau for visualization, and SAS for correlation and descriptive statistics. Approaches for analysis include ranking, association, and data visualization of the health and education data.

Analyses and results

In this section we identify and analyze patterns and associations between education and health indicators and discuss the results. Since countries vary in population sizes and other criteria, we use the estimated averages in all our analyses.

Comparison of health outcomes for countries by GDP per capita

We first analyzed to see if our data reflected the expectation that countries with higher GDP per capita have better health status (Fig. 1 ). We compared the average life expectancy at birth, average infant mortality, average deaths from cancer and average potential year of life lost, for different levels of GDP per capita (Fig. 1 ).

Associations between Average Life Expectancy (years) and Average Infant Mortality rate (per 1000), and between Deaths from Cancer (rates per 100,000) and Average Potential Years of Life Lost (years), by GDP per capita (for all countries for years 1995–2015)

Figure 1 depicts two charts with the estimated averages of variables for all countries in the sample. The X-axis of the first chart depicts average infant mortality rate (per 1000), while that of the second chart depicts average potential years of life lost (years). The Y-axis for both charts depicts the GDP per capita shown in intervals of 10 K ranging from 0 K–110 K (US Dollars). The analysis is shown as an average for all the countries in the sample and for all the years (1995–2015). As seen in Fig. 1 , countries with lower GDP per capita have higher infant mortality rate and increased potential year of life lost (which represents the average years a person would have lived if he or she had not died prematurely - a measure of premature mortality). Life expectancy and deaths from cancer are not affected by GDP level. When studying infant mortality and potential year lost, in order to avoid the influence of a control variable, it was necessary to group the samples by their GDP per capita level.

Association of Infant Mortality Rates with enrollment rates and education levels

We explored the association of infant mortality rates with the enrollment rates and adult educational levels for all countries (Fig. 2 ). The expectation is that with higher education and employment the infant mortality rate decreases.

Association of Adult Education Levels (ratio) and Enrollment Rates (ratio) with Infant Mortality Rate (per 1000)

Figure 2 depicts the analysis for all countries in the sample. The figure shows the years from 1995 to 2015 on the X axis. It shows two Y-axes with one axis denoting average infant mortality rate (per 1000 live births), and the other showing the rates from 0 to 120 to depict enrollment rates (primary/secondary/tertiary) and education levels (below secondary/upper secondary/tertiary). Regarding the Y axis showing rates over 100, it is worth noting that the enrollment rates denote a ratio of the total enrollment (regardless of age) at a level of education to the official population of the age group in that education level. Therefore, it is possible for the number of children enrolled at a level to exceed the official population of students in the age group for that level (due to repetition or late entry). This can lead to ratios over 100%. The figure shows that in general, all education indicators tend to rise over time, except for adult education level below secondary, which decreases over time. Infant mortality shows a steep decreasing trend over time, which is favorable. In general, countries have increasing health status and education over time, along with decreasing infant mortality rates. This suggests a negative association of education and enrollment rates with mortality rates.

Association of Education Outcomes with life expectancy at birth

We explored if the education outcomes of adult education level (tertiary), school life expectancy (tertiary), and NEET (not in employment, education, or training) rates, affected life expectancy at birth (Fig. 3 ). Our expectation is that adult education and school life expectancy, particularly tertiary, have a positive influence, while NEET has an adverse influence, on life expectancy at birth.

Association of Adult Education Level (Tertiary), NEET rate, School Life Expectancy (Tertiary), with Life Expectancy at Birth

Figure 3 show the relationships between various education indicators (adult education level-tertiary, NEET rate, school life expectancy-tertiary) and life expectancy at birth for all countries in the sample. The figure suggests that life expectancy at birth rises as adult education level (tertiary) and tertiary school life expectancy go up. Life expectancy at birth drops as the NEET rate goes up. In order to extend people’s life expectancy, governments should try to improve tertiary education, and control the number of youths dropping out of school and ending up unemployed (the NEET rate).

Association of Tertiary Enrollment and Education with potential years of life lost

We wanted to explore if the potential years of life lost rates are affected by tertiary enrollment rates and tertiary adult education levels (Fig. 4 ).

Association of Enrollment rate-tertiary (top) and Adult Education Level-Tertiary (bottom) with Potential Years of Life Lost (Y axis)

The two sets of box plots in Fig. 4 compare the enrollment rates with potential years of life lost (above set) and the education level with potential years of life lost (below set). The analysis is for all countries in the sample. As mentioned earlier, the enrollment rates are expressed as ratios and can exceed 100% if the number of children enrolled at a level (regardless of age) exceed the official population of students in the age group for that level. Potential years of life lost represents the average years a person would have lived, had he/she not died prematurely. The results show that with the rise of tertiary adult education level and tertiary enrollment rate, there is a decrease in both value and variation of the potential years of life lost. We can conclude that lower levels in tertiary education adversely affect a country’s health situation in terms of premature mortality.

Association of Tertiary Enrollment and Education with child vaccination rates

We compared the performance of tertiary education level and enrollment rates with the child vaccination rates (Fig. 5 ) to assess if there was a positive impact of education on preventive healthcare.

Association of Adult Education Level-Tertiary and Enrollment Rate-Tertiary with Child Vaccination Rates

In this analysis (Fig. 5 ), we looked for associations of child vaccination rates with tertiary enrollment and tertiary education. The analysis is for all countries in the sample. The color of the bubble represents the tertiary enrollment rate such that the darker the color, the higher the enrollment rate, and the size of the bubble represents the level of tertiary education. The labels inside the bubbles denote the child vaccination rates. The figure shows a general positive association of high child vaccination rate with tertiary enrollment and tertiary education levels. This indicates that countries that have high child vaccination rates tend to be better at tertiary enrollment and have more adults educated in tertiary institutions. Therefore, countries that focus more on tertiary education and enrollment may confer more health awareness in the population, which can be reflected in improved child vaccination rates.

Association of NEET rates (15–19; 20–24) with infant mortality rates and deaths from Cancer

In the realm of child health, we also looked at the infant mortality rates. We explored if infant mortality rates are associated with the NEET rates in different age groups (Fig. 6 ).

Association of Infant Mortality rates with NEET Rates (15–19) and NEET Rates (20–24)

Figure 6 is a scatterplot that explores the correlation between infant mortality and NEET rates in the age groups 15–19 and 20–24. The data is for all countries in the sample. Most data points are clustered in the lower infant mortality and lower NEET rate range. Infant mortality and NEET rates move in the same direction—as infant mortality increases/decrease, the NEET rate goes up/down. The NEET rate for the age group 20–24 has a slightly higher infant mortality rate than the NEET rate for the age group 15–19. This implies that when people in the age group 20–24 are uneducated or unemployed, the implications on infant mortality are higher than in other age groups. This is a reasonable association, since there is the potential to have more people with children in this age group than in the teenage group. To reduce the risk of infant mortality, governments should decrease NEET rates through promotional programs that disseminate the benefits of being educated, employed, and trained [ 7 ]. Additionally, they can offer financial aid to public schools and companies to offer more resources to raise general health awareness in people.

We looked to see if the distribution of population without employment, education, or training (NEET) in various categories of high, medium, and low impacted the rate of deaths from cancer (Fig. 7 ). Our expectation is that high rates of NEET will positively influence deaths from cancer.

Association of Deaths from Cancer and different NEET Rates

The three pie charts in Fig. 7 show the distribution of deaths from cancer in groups of countries with different NEET rates (high, medium, and low). The analysis includes all countries in the sample. The expectation was that high rates of NEET would be associated with high rates of cancer deaths. Our results, however, show that countries with medium NEET rates tend to have the highest deaths from cancer. Countries with high NEET rates have the lowest deaths from cancer among the three groups. Contrary to expectations, countries with low NEET rates do not show the lowest death rates from cancer. A possible explanation for this can be attributed to the fact that in this group, the people in the labor force may be suffering from work-related hazards including stress, that endanger their health.

Association between adult education levels and health expenditure

It is interesting to note the relationship between health expenditure and adult education levels (Fig. 8 ). We expect them to be positively associated.

Association of Health Expenditure and Adult Education Level-Tertiary & Upper Secondary

Figure 8 shows a heat map with the number of countries in different combinations of groups between tertiary and upper-secondary adult education level. We emphasize the higher levels of adult education. The color of the square shows the average of health expenditure. The plot shows that most of the countries are divided into two clusters. One cluster has a high tertiary education level as well as a high upper-secondary education level and it has high average health expenditure. The other cluster has relatively low tertiary and upper secondary education level with low average health expenditure. Overall, the figure shows a positive correlation between adult education level and compulsory health expenditure. Governments of countries with low levels of education should allocate more health expenditure, which will have an influence on the educational levels. Alternatively, to improve public health, governments can frame educational policies to improve the overall national education level, which then produces more health awareness, contributing to national healthcare.

Association of Compulsory Health Expenditure with NEET rates by country and region

Having explored the relationship between health expenditure and adult education, we then explored the relationship between health expenditure and NEET rates of different countries (Fig. 9 ). We expect compulsory health expenditure to be negatively associated with NEET rates.

Association between Compulsory Health Expenditure and NEET Rate by Country and Region

In Fig. 9 , each box represents a country or region; the size of the box indicates the extent of compulsory health expenditure such that a larger box implies that the country has greater compulsory health expenditure. The intensity of the color of the box represents the NEET rate such that the darker color implies a higher NEET rate. Turkey has the highest NEET rate with low health expenditure. Most European countries such as France, Belgium, Sweden, and Norway have low NEET rates and high health expenditure. The chart shows a general association between low compulsory health expenditure and high NEET rates. The relationship, however, is not consistent, as there are countries with high NEET and high health expenditures. Our suggestion is for most countries to improve the social education for the youth through free training programs and other means to effectively improve the public health while they attempt to raise the compulsory expenditure.

Distribution of life expectancy at birth and tertiary enrollment rate

The distribution of enrollment rate (tertiary) and life expectancy of all the countries in the sample can give an idea of the current status of both education and health (Fig. 10 ). We expect these to be positively associated.

Distribution of Life Expectancy at Birth (years) and Tertiary Enrollment Rate

Figure 10 shows two histograms with the lines representing the distribution of life expectancy at birth and the tertiary enrollment rate of all the countries. The distribution of life expectancy at birth is skewed right, which means most of the countries have quite a high life expectancy and there are few countries with a very low life expectancy. The tertiary enrollment rate has a good distribution, which is closer to a normal distribution. Governments of countries with an extremely low life expectancy should try to identify the cause of this problem and take actions in time to improve the overall national health.

Comparison of adult education levels and deaths from Cancer at various levels of GDP per capita

We wanted to see if various levels of GDP per capita influence the levels of adult education and deaths from cancer in countries (Fig. 11 ).

Comparison of Adult Education Levels and Deaths from Cancer at various levels of GDP per capita

Figure 11 shows the distribution of various adult education levels for countries by groups of GDP per capita. The plot shows that as GDP grows, the level of below-secondary adult education becomes lower, and the level of tertiary education gets higher. The upper-secondary education level is constant among all the groups. The implication is that tertiary education is the most important factor among all the education levels for a country to improve its economic power and health level. Countries should therefore focus on tertiary education as a driver of economic development. As for deaths from cancer, countries with lower GDP have higher death rates, indicating the negative association between economic development and deaths from cancer.

Distribution of infant mortality rates by continent

Infant mortality is an important indicator of a country’s health status. Figure 12 shows the distribution of infant mortality for the continents of Asia, Europe, Oceania, North and South America. We grouped the countries in each continent into high, medium, and low, based on infant mortality rates.

Distribution of Infant Mortality rates by Continent

In Fig. 12 , each bar represents a continent. All countries fall into three groups (high, medium, and low) based on infant mortality rates. South America has the highest infant mortality, followed by Asia, Europe, and Oceania. North America falls in the medium range of infant mortality. South American countries, in general, should strive to improve infant mortality. While Europe, in general, has the lowest infant mortality rates, there are some countries that have high rates as depicted.

Association between child vaccination rates and NEET rates

We looked at the association between child vaccination rates and NEET rates in various countries (Fig. 13 ). We expect countries that have high NEET rates to have low child vaccination rates.

Association between Child Vaccination Rates and NEET rates

Figure 13 displays the child vaccination rates in the first map and the NEET rates in the second map, for all countries. The darker green color shows countries with higher rates of vaccination and the darker red represents those with higher NEET rates. It can be seen that in general, the countries with lower NEET also have better vaccination rates. Examples are USA, UK, Iceland, France, and North European countries. Countries should therefore strive to reduce NEET rates by enrolling a good proportion of the youth into initiatives or programs that will help them be more productive in the future, and be able to afford preventive healthcare for the families, particularly, the children.

Average smoking rate in different continents over time

We compared the trend of average smoking rate for the years 1995–201 for the continents in the sample (Fig. 14 ).

Trend of average smoking rate in different continents from 1995 to 2015

Figure 14 depicts the line charts of average smoking rates for the continents of Asia, Europe, Oceania, North and South America. All the lines show an overall downward trend, which indicates that the average smoking rate decreases with time. The trend illustrates that people have become more health conscious and realize the harmful effects of smoking over time. However, the smoking rate in Europe (EU) is consistently higher than that in other continents, while the smoking rate in North America (NA) is consistently lower over the years. Governments in Europe should pay attention to the usage of tobacco and increase health consciousness among the public.

Association between adult education levels and deaths from Cancer

We explored if adult education levels (below-secondary, upper-secondary, and tertiary) are associated with deaths from cancer (Fig. 15 ) such that higher levels of education will mitigate the rates of deaths from cancer, due to increased awareness and proactive health behavior.

Association of deaths from cancer with adult education levels

Figure 15 shows the correlations of deaths from cancer among the three adult education levels, for all countries in the sample. It is obvious that below-secondary and tertiary adult education levels have a negative correlation with deaths from cancer, while the upper-secondary adult education level shows a positive correlation. Barring upper-secondary results, we can surmise that in general, as education level goes higher, the deaths from cancer will decrease. The rationale for this could be that education fosters more health awareness and encourages people to adopt healthy behavioral practices. Governments should therefore pay attention to frame policies that promote education. However, the counterintuitive result of the positive correlation between upper-secondary levels of adult education with the deaths from cancer warrants more investigation.

We drilled down further into the correlation between the upper-secondary education level and deaths from cancer. Figure 16 shows this correlation, along with a breakdown of the total number of records for each continent, to see if there is an explanation for the unique result.

Association between deaths from cancer and adult education level-upper secondary

Figure 16 shows a dashboard containing two graphs - a scatterplot of the correlation between deaths from cancer and education level, and a bar graph showing the breakdown of the total sample by continent. We included a breakdown by continent in order to explore variances that may clarify or explain the positive association for deaths from cancer with the upper-secondary education level. The scatterplot shows that for the European Union (EU) the points are much more scattered than for the other continents. Also, the correlation between deaths and education level for the EU is positive. The bottom bar graph depicts how the sample contains a disproportionately high number of records for the EU than for other continents. It is possible that this may have influenced the results of the correlation. The governments in the EU should investigate the reasons behind this phenomenon. Also, we defer to future research to explore this in greater detail by incorporating other socioeconomic parameters that may have to be factored into the relationship.

Association between average tertiary school life expectancy and health expenditure

We moved our focus to the trends of tertiary school life expectancy and health expenditure from 1995 to 2015 (Fig. 17 ) to check for positive associations.

Association between Average Tertiary School Life Expectancy and Health Expenditure

Figure 17 is a combination chart explaining the trends of tertiary school life expectancy and health expenditure, for all countries in the sample. The rationale is that if there is a positive association between the two, it would be worthwhile for the government to allocate more resources towards health expenditure. Both tertiary school life expectancy and health expenditure show an increase over the years from 1995 to 2015. Our additional analysis shows that they continue to increase even after 2015. Hence, governments are encouraged to increase the health expenditure in order to see gains in tertiary school life expectancy, which will have positive implications for national health. Given that the measured effects of education are large, investments in education might prove to be a cost-effective means of achieving better health.

Our results reveal how interlinked education and health can be. We show how a country can improve its health scenario by focusing on appropriate indicators of education. Countries with higher education levels are more likely to have better national health conditions. Among the adult education levels, tertiary education is the most critical indicator influencing healthcare in terms of infant mortality, life expectancy, child vaccination rates, and enrollment rates. Our results emphasize the role that education plays in the potential years of life lost, which is a measure that represents the average years a person would have lived had he/she not died prematurely. In addition to mortality rate, an economy needs to consider this indicator as a measure of health quality.

Other educational indicators that are major drivers of health include school life expectancy, particularly at the tertiary level. In order to improve the school life expectancy of the population, governments should control the number of youths ending up unemployed, dropping out of school, and without skills or training (the NEET rate). Education allows people to gain skills/abilities and knowledge on general health, enhancing their awareness of healthy behaviors and preventive care. By targeting promotions and campaigns that emphasize the importance of skills and employment, governments can reduce the NEET rates. And, by reducing the NEET rates, governments have the potential to address a broad array of vulnerabilities among youth, ranging from unemployment, early school dropouts, and labor market discouragement, which are all social issues that warrant attention in a growing economy.

We also bring to light the health disparities across countries and suggest implications for governments to target educational interventions that can reduce inequalities and improve health, at a macro level. The health effects of education are at the grass roots level - creating better overall self-awareness on personal health and making healthcare more accessible.

Scope and limitations

Our research suffers from a few limitations. For one, the number of countries is limited, and being that the data are primarily drawn from OECD, they pertain to the continent of Europe. We also considered a limited set of variables. A more extensive study can encompass a larger range of variables drawn from heterogeneous sources. With the objective of acquiring a macro perspective on the education–health association, we incorporated some dependent variables that may not traditionally be viewed as pure health parameters. For example, the variable potential years of life lost is affected by premature deaths that may be caused by non-health related factors too. Also there may be some intervening variables in the education–health relationship that need to be considered. Lastly, while our study explores associations and relationships between variables, it does not investigate causality.

Conclusions and future research

Both education and health are at the center of individual and population health and well-being. Conceptualizations of both phenomena should go beyond the individual focus to incorporate and consider the social context and structure within which the education–health relationship is embedded. Such an approach calls for a combination of interdisciplinary research, novel conceptual models, and rich data sources. As health differences are widening across the world, there is need for new directions in research and policy on health returns on education and vice versa. In developing interventions and policies, governments would do well to keep in mind the dual role played by education—as a driver of opportunity as well as a reproducer of inequality [ 36 ]. Reducing these macro-level inequalities requires interventions directed at a macro level. Researchers and policy makers have mutual responsibilities in this endeavor, with researchers investigating and communicating the insights and recommendations to policy makers, and policy makers conveying the challenges and needs of health and educational practices to researchers. Researchers can leverage national differences in the political system to study the impact of various welfare systems on the education–health association. In terms of investment in education, we make a call for governments to focus on education in the early stages of life course so as to prevent the reproduction of social inequalities and change upcoming educational trajectories; we also urge governments to make efforts to mitigate the rising dropout rate in postsecondary enrollment that often leads to detrimental health (e.g., due to stress or rising student debt). There is a need to look into the circumstances that can modify the postsecondary experience of youth so as to improve their health.

Our study offers several prospects for future research. Future research can incorporate geographic and environmental variables—such as the quality of air level or latitude—for additional analysis. Also, we can incorporate data from other sources to include more countries and more variables, especially non-European ones, so as to increase the breadth of analysis. In terms of methodology, future studies can deploy meta-regression analysis to compare the relationships between health and some macro-level socioeconomic indicators [ 13 ]. Future research should also expand beyond the individual to the social context in which education and health are situated. Such an approach will help generate findings that will inform effective educational and health policies and interventions to reduce disparities.

Availability of data and materials

The dataset analyzed during the current study is available from the corresponding author on reasonable request.

Abbreviations

Fundamental Cause Theory

Human Capital Theory

Not in Employment, Education, or Training

Organization for Economic Cooperation and Development

Socio-economic status

Andersen RM, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973;51(1):95–124.

Article   CAS   Google Scholar  

Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Social Behav. 1995;36(1):1–10.

Baker DP. The Schooled Society: The Educational Transformation of Global Culture. Stanford, CA: Stanford Univ. Press: 2014; 360.

Becker GS. Human capital: a theoretical and empirical analysis, with special reference to education. Chicago: Univ. Chicago Press; 1964.

Google Scholar  

Berkman LF, Syme SL. Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Oxford Acad J. 1979;109(2):186–204.

CAS   Google Scholar  

Crimmins EM, Kim JK, Vasunilashorn S. Biodemography: new approaches to understanding trends and differences in population health and mortality. Demography. 2010;47:S41–64.

Article   Google Scholar  

Spence M. Job market signalling. The Quarterly J Econ. 1973;87:355–79.

Cutler DM, Lleras-Muney A. Education and Health: Evaluating Theories and Evidence: NBER Working Papers; 2006. p. 12352.

Feinstein L. What are the effects of education on health? OECD Proceedings of the Copenhagen Symposium; 2006 . .

Folkman S, Lazarus RS. An analysis of coping in a middle-aged community sample. J Health Soc Behav. 1980;21(3):219–39.

Freedman VA, Martin LG. The role of education in explaining and forecasting trends in functional limitations among older Americans. Demography. 1999;36(4):461–73.

Freese J, Lutfey K. Fundamental causality: challenges of an animating concept for medical sociology. In: Pescosolido BA, Martin JK, McLeod JD, Rogers A, editors. Handbook of the Sociology of Health, Illness, and Healing: a blueprint for the 21st century. New York: Springer; 2011. p. 67–81.

Chapter   Google Scholar  

Fouweather T, Gillies C, Wohland P, Van Oyen H, Nusselde W, Robine J, Cambois E, Jagger C. Comparison of socio-economic indicators explaining inequalities in healthy life years at age 50 in Europe: 2005 and 2010. Eur J Pub Health. 2015;25:978–83.

George LK, Gwyther LP. Caregiver Weil-being: a multidimensional examination of family caregivers of demented adults. Gerontologist. 1986;26(3):253–9.

Goldman D, Smith JP. The increasing value of education to health. Soc Sc Med. 2011;72(10):1728–37.

Harper AC, Lambert LJ. The health of populations: an introduction. New York: Springer Publishing Company; 1994.

Health 2020: Education and health through the life-course. WHO Europe Sector Brief on Education Health; 2015. http://www.euro.who.int/__data/assets/pdf_file/0007/324619/Health-2020-Education-and-health-through-the-life-course-en.pdf?ua=1 .

Kino S, Bernabé E, Sabbah W. The role of healthcare and education systems in co-occurrence of health risk behaviours in 27 European countries. Eur J Public Health. 2018;28(1):186–92.

Landerman LR, Burns BJ, Swartz MS, Wagner HR, George LK. The relationship between insurance coverage and psychiatric disorder in predicting use of mental health services. Am J Psychol. 1994;151(12):1785.

Lynch SM. Cohort and life-course patterns in the relationship between education and health: a hierarchical approach. Demography. 2003;40(2):309–31.

Mackenbach J, Kunst A. Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997;44(6):757–71. https://doi.org/10.1016/S0277-9536(96)00073-1 .

Article   CAS   PubMed   Google Scholar  

Manton KG, Corder L, Stallard E. Chronic disability trends in elderly United States populations: 1982-1994. Natl Acad Sci. 1997;94(6):2593–8.

Mirowski J, Ross CE. Education, learned effectiveness and health. London Rev Edu. 2005;3(3):205–20.

Montez JK, Berkman LF. Trends in the educational gradient of mortality among US adults aged 45 to 84 years: bringing regional context into the explanation. Am J Pub Health. 2014;104(1):e82–90.

Montez JK, Zajacova A. Trends in mortality risk by education level and cause of death among US white women from 1986 to 2006. Am J Pub Health. 2013;103:473–9.

Olshansky SJ, Antonucci T, Berkman L, Binstock RH, Boersch-Supan A, Cacioppo JT, Carnes BA, Carstensen LL, Fried LP, Goldman DP, Jackson J, Kohli M, Rother J, Zheng Y, Rowe J. Differences in life expectancy due to race and educational differences are widening, and many may not catch up. Health Aff. 2012;31(8):1803–13.

Pamuk ER. Social-class inequality in infant mortality in England and Wales from 1921 to 1980. Eur J Popul 1988; 4 , 1–21, https://doi.org/10.1007/BF01797104.

Phelan JC , Link BG , Tehranifar P . Social conditions as fundamental causes of health inequalities: Theory, evidence, and policy implications . J Health Soc Behav 2010 ; 51 : S28 S40 . doi : 10.1177/0022146510383498.

Renard F, Devleesschauwer B, Speybroeck N, Deboosere P. Monitoring health inequalities when the socio-economic composition changes: are the slope and relative indices of inequality appropriate? Results of a simulation study. BMC Public Health 2019; 19: 662. https://doi.org/10.1186/s12889-019-6980-1.

Ro A, Geronimus A, Bound J, Griffith D, Gee G. Educational gradients in five Asian immigrant populations: do country of origin, duration and generational status moderate the education-health relationship? Prev Med Rep. 2016;4:338–43.

Ross CE, Wu CL. The links between education and health. Am Soc Rev. 1995;60(5):719–45.

Shiels MS, Chernyavskiy P, Anderson WF, Best AF, Haozous EA. Diverging trends in premature mortality in the U.S. by sex, race, and ethnicity in the 21st century. Lancet. 2017;389:1043–54.

Tsou MT. Association of Education, health behaviors, concerns, and knowledge with metabolic syndrome among urban elderly in one medical Center in Taiwan. Int J Gerontology. 2017;11(3:138–43.

Wheaton B. Stress, personal coping resources, and psychiatric symptoms: an investigation of interactive models. J Health Soc Behav. 1983;24(3):208–29.

Williams DR, Collins C. US socioeconomic and racial differences in health: patterns and explanations. Ann Rev Soc. 1995;21:349–86.

Zajacova A, Lawrence EM. The relationship between education and health: reducing disparities through a contextual approach. Ann Rev Pub Health. 2018;39:273–89.

Zimmerman EB, Woolf SH. Understanding the relationship between education and health. Discussion Paper, Inst Med. Washington DC; 2014. https://nam.edu/wp-content/uploads/2015/06/BPH-UnderstandingTheRelationship1.pdf .

Zhong H. An over time analysis on the mechanisms behind the education–health gradients in China. China Econ Rev. 2015;34(C):135–49.

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Raghupathi, V., Raghupathi, W. The influence of education on health: an empirical assessment of OECD countries for the period 1995–2015. Arch Public Health 78 , 20 (2020). https://doi.org/10.1186/s13690-020-00402-5

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• Enrollment rate
• Life expectancy
• Potential years of life lost
• Infant mortality
• Deaths from cancer

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Making judgments based on reported observations of trainee performance: a scoping review in Health Professions Education

• Audrey-Ann Lefebvre University of Sherbrooke
• Christina St-Onge University of Sherbrooke

Background: Educators now use reported observations when assessing trainees’ performance. Unfortunately, they have little information about how to design and implement assessments based on reported observations.

Objective: The purpose of this scoping review was to map the literature on the use of reported observations in judging health professions education (HPE) trainees' performances.

Methods: Arksey and O'Malley’s (2005) method was used with four databases (sources: ERIC, CINAHL, MEDLINE, PsycINFO). Eligibility criteria for articles were: documents in English or French, including primary data, and initial or professional training; (2) training in an HPE program; (3) workplace-based assessment; and (4) assessment based on reported observations. The inclusion/exclusion, and data extraction steps were performed (agreement rate > 90%). We developed a data extraction grid to chart the data. Descriptive analyses were used to summarize quantitative data, and the authors conducted thematic analysis for qualitative data.

Results: Based on 36 papers and 13 consultations, the team identified six steps characterizing trainee performance assessment based on reported observations in HPE: (1) making first contact, (2) observing and documenting the trainee performance, (3) collecting and completing assessment data, (4) aggregating assessment data, (5) inferring the level of competence, and (6) documenting and communicating the decision to the stakeholders.

Discussion: The design and implementation of assessment based on reported observations is a first step towards a quality implementation by guiding educators and administrators responsible for graduating competent professionals. Future research might focus on understanding the context beyond assessor cognition to ensure the quality of meta-assessors’ decisions.

Author Biographies

Marie-eve poitras, university of sherbrooke.

RN., PhD., Assistant Professor, Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada

Audrey-Ann Lefebvre, University of Sherbrooke

PhD candidate in psychology, Department of Psychology, Faculty of Human Arts and Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada

Christina St-Onge, University of Sherbrooke

PhD, Full Professor, Department of Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada

Gofton W, Dudek N, Barton G, Bhanji F. Workplace-based assessment implementation guide: formative tips for medical teaching practice. R Coll Physicians Surg Can. 2017;1‑12.

Holmboe ES, Sherbino J, Long DM, Swing SR, Frank JR. The role of assessment in competency-based medical education. Med Teach. 2010;32(8):676‑82. https://doi.org/10.3109/0142159X.2010.500704

Gingerich A, Kogan J, Yeates P, Govaerts M, Holmboe E. Seeing the « black box » differently: assessor cognition from three research perspectives. Med Educ. 2014;48(11):1055‑68. https://doi.org/10.1111/medu.12546

Kinnear B, Warm EJ, Hauer KE. Twelve tips to maximize the value of a clinical competency committee in postgraduate medical education. Med Teach. 2018;40(11):1110‑5. https://doi.org/10.1080/0142159X.2018.1474191

Schuwirth LWT, van der Vleuten CPM. A history of assessment in medical education. Adv Health Sci Educ. 2020;25(5):1045‑56. https://doi.org/10.1007/s10459-020-10003-0

van der Vleuten CPM, Schuwirth LWT, Driessen EW, et al. A model for programmatic assessment fit for purpose. Med Teach. 2012;34(3):205‑14. https://doi.org/10.3109/0142159X.2012.652239

Hodges B. Assessment in the post-psychometric era: learning to love the subjective and collective. Med Teach. 2013;35(7):564‑8. https://doi.org/10.3109/0142159X.2013.789134

Colbert CY, French JC, Herring ME, Dannefer EF. Fairness: the hidden challenge for competency-based postgraduate medical education programs. Perspect Med Educ. 2017;6:347‑55. https://doi.org/10.1007/s40037-017-0359-8

Colbert CY, Dannefer EF, French JC. Clinical competency committees and assessment: changing the conversation in graduate medical education. J Grad Med Educ. 2015;7(2):162‑5. https://doi.org/10.4300/JGME-D-14-00448.1

French JC, Dannefer EF, Colbert CY. A systematic approach toward building a fully operational clinical competency committee. J Surg Educ. 2014;71(6):e22‑7. https://doi.org/10.1016/j.jsurg.2014.04.005

Larocque S, Luhanga FL. Exploring the issue of failure to fail in a nursing program. Int J Nurs Educ Scholarsh. 2013;10(1):115‑22. https://doi.org/10.1515/ijnes-2012-0037

Kane M. The argument-based approach to validation. Sch Psychol Rev. 2013;42(4):448‑57. https://doi.org/10.1080/02796015.2013.12087465

Kane MT. Validating the interpretations and uses of test scores. J Educ Meas. 2013;50(1):1‑73. https://doi.org/10.1111/jedm.12000

Zumbo BD, Chan EKH. Validity and validation in social, behavioral, and health sciences. Cham: Springer; 2014. https://doi.org/10.1007/978-3-319-07794-9

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19‑32. https://doi.org/10.1080/1364557032000119616

Peters MDJ, Marnie C, Tricco AC, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18(10):2119‑26. https://doi.org/10.11124/JBIES-20-00167

Levac D, Colquhoun H, O’Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. https://doi.org/10.1186/1748-5908-5-69

Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467‑73. https://doi.org/10.7326/M18-0850

Thomas A, Lubarsky S, Durning SJ, Young ME. Knowledge syntheses in medical education: demystifying scoping reviews. Acad Med. 2017;92(2):161‑6. https://doi.org/10.1097/ACM.0000000000001452

Braun V, Clarke V. Can I use TA? Should I use TA? Should I not use TA? Comparing reflexive thematic analysis and other pattern‐based qualitative analytic approaches. Couns Psychother Res. 2021;21(1):37‑47. https://doi.org/10.1002/capr.12360

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77‑101. https://doi.org/10.1191/1478088706qp063oa

Donato AA, Alweis R, Wenderoth S. Design of a clinical competency committee to maximize formative feedback. J Community Hosp Intern Med Perspect JCHIMP. 2016;6(6):33533. https://doi.org/10.3402/jchimp.v6.33533

Moonen-van Loon JMW, Overeem K, Govaerts MJB, Verhoeven BH, van der Vleuten CPM, Driessen EW. The reliability of multisource feedback in competency-based assessment programs: the effects of multiple occasions and assessor groups. Acad Med. 2015;90(8):1093‑9. https://doi.org/10.1097/ACM.0000000000000763

Keeley MG, Gusic ME, Morgan HK, Aagaard EM, Santen SA. Moving toward summative competency assessment to individualize the postclerkship phase. Acad Med. 2019;94(12):1858‑64. https://doi.org/10.1097/ACM.0000000000002830

Hemmer PA, Hawkins R, Jackson JL, Pangaro LN. Assessing how well three evaluation methods detect deficiencies in medical students’ professionalism in two settings of an internal medicine clerkship. Acad Med. 2000;75(2):167‑73. https://doi.org/10.1097/00001888-200002000-00016

Murray KE, Lane JL, Carraccio C, et al. Crossing the gap: using competency-based assessment to determine whether learners are ready for the undergraduate-to-graduate transition. Acad Med. 2019;94(3):338‑45. https://doi.org/10.1097/ACM.0000000000002535

Hicks PJ, Margolis MJ, Carraccio CL, et al. A novel workplace-based assessment for competency-based decisions and learner feedback. Med Teach. 2018;40(11):1143‑50. https://doi.org/10.1080/0142159X.2018.1461204

Rich JV, Fostaty Young S, Donnelly C, et al. Competency-based education calls for programmatic assessment: but what does this look like in practice? J Eval Clin Pract. 2019;26(4):95. https://doi.org/10.1111/jep.13328

Driessen EW, van Tartwijk J, Govaerts M, Teunissen P, van der Vleuten CP. The use of programmatic assessment in the clinical workplace: a Maastricht case report. Med Teach. 2012;34(3):226‑31. https://doi.org/10.3109/0142159X.2012.652242

Cianciolo AT, Hingle S, Hudali T, Beason AM. Evaluating clerkship competency without exams. Clin Teach. 2020;17(6):624‑8. https://doi.org/10.1111/tct.13114

Lass SL, Kornreich HK, Hoffmann KI, Friedman DB. Consistency in ratings of clinical performance of the same students throughout medical school and internship. Annual Conference on Research in Medical Education. Conference on Research in Medical Education. 1977;16:147‑52. PMID: 606069

Perry M, Linn A, Munzer BW, et al. Programmatic assessment in emergency medicine: implementation of best practices. J Grad Med Educ. 2018;10(1):84‑90. https://doi.org/10.4300/JGME-D-17-00094.1

Helminen K, Tossavainen K, Turunen H. Assessing clinical practice of student nurses: views of teachers, mentors and students. Nurse Educ Today. 2014;34(8):1161‑6. https://doi.org/10.1016/j.nedt.2014.04.007

Duitsman ME, Fluit CRMG, van der Goot WE, et al. Judging residents’ performance: a qualitative study using grounded theory. BMC Med Educ. 2019;19(1):13. https://doi.org/10.1186/s12909-018-1446-1

Hemmer PA, Dadekian GA, Terndrup C, et al. Regular formal evaluation sessions are effective as frame-of-reference training for faculty evaluators of clerkship medical students. J Gen Intern Med. 2015;30(9):1313‑8. https://doi.org/10.1007/s11606-015-3294-6

Yonge O, Myrick F, Ferguson LM. Preceptored students in rural settings want feedback. Int J Nurs Educ Scholarsh. 2011;8(1). https://doi.org/10.2202/1548-923X.2047

Battistone M, Pendleton B, Milne C, et al. Global descriptive evaluations are more responsive than global numeric ratings in detecting students’ progress during the inpatient portion of an internal medicine clerkship. Acad Med. 2001;76(10):S105‑7. https://doi.org/10.1097/00001888-200110001-00035

Wu XV, Enskär K, Pua LH, Heng DGN, Wang W. Clinical nurse leaders’ and academics’ perspectives in clinical assessment of final‐year nursing students: a qualitative study. Nurs Health Sci. 2017;19(3):287‑93. https://doi.org/10.1111/nhs.12342

Borman KR, Augustine R, Leibrandt T, Pezzi CM, Kukora JS. Initial performance of a modified milestones global evaluation tool for semiannual evaluation of residents by faculty. J Surg Educ. 2013;70(6):739‑49. https://doi.org/10.1016/j.jsurg.2013.08.004

Hauer KE, Chesluk B, Iobst W, et al. Reviewing residents’ competence: a qualitative study of the role of clinical competency committees in performance assessment. Acad Med. 2015;90(8):1084‑92. https://doi.org/10.1097/acm.0000000000000736

Goodyear HM, Lakshminarayana I, Wall D, Bindal T. A multisource feedback tool to assess ward round leadership skills of senior paediatric trainees: (2) Testing reliability and practicability. Postgrad Med J. 2015;91(1075):268‑73. https://doi.org/10.1136/postgradmedj-2015-133308

Ekpenyong A, Baker E, Harris I, et al. How do clinical competency committees use different sources of data to assess residents’ performance on the internal medicine milestones? A mixed methods pilot study. Med Teach. 2017;39(10):1074‑83. https://doi.org/10.1080/0142159X.2017.1353070

Swing SR, Clyman SG, Holmboe ES, Williams RG. Advancing resident assessment in graduate medical education. J Grad Med Educ. 2009;1(2):278‑86. https://doi.org/10.4300/JGME-D-09-00010.1

Berger JS, Pan E, Thomas J. A randomized, controlled crossover study to discern the value of 360-degree versus traditional, faculty-only evaluation for performance improvement of anesthesiology residents. J Educ Perioper Med JEPM. 2009;11(2):E053. https://doi.org/10.46374/volxi-issue2-berger

Nabors C, Forman L, Peterson SJ, et al. Milestones: a rapid assessment method for the Clinical Competency Committee. Arch Med Sci. 2017;13(1):201‑9. https://doi.org/10.5114/aoms.2016.64045

Chan TM, Sherbino J, Mercuri M. Nuance and noise: lessons learned from longitudinal aggregated assessment data. J Grad Med Educ. 2017;9(6):724‑9. https://doi.org/10.4300/JGME-D-17-00086.1

Hauer KE, Clauser J, Lipner RS, et al. The internal medicine reporting milestones: cross-sectional description of initial implementation in U.S. residency programs. Ann Intern Med. 2016;165(5):356‑62. https://doi.org/10.7326/M15-2411

Friedman KA, Balwan S, Cacace F, Katona K, Sunday S, Chaudhry S. Impact on house staff evaluation scores when changing from a Dreyfus- to a Milestone-based evaluation model: one internal medicine residency program’s findings. Med Educ Online. 2014;19(1). https://doi.org/10.3402/meo.v19.25185

Aagaard E, Kane GC, Conforti L, et al. Early feedback on the use of the internal medicine reporting milestones in assessment of resident performance. J Grad Med Educ. 2013;5(3):433‑8. https://doi.org/10.4300/JGME-D-13-00001.1

Chan TM, Sebok-Syer SS, Sampson C, Monteiro S. The quality of assessment of learning (Qual) score: validity evidence for a scoring system aimed at rating short, workplace-based comments on trainee performance. Teach Learn Med. 2020;32(3):319‑29. https://doi.org/10.1080/10401334.2019.1708365

Ogunyemi D, Eno M, Rad S, Fong A, Alexander C, Azziz R. Evaluating professionalism, practice-based learning and improvement, and systems-based practice: utilization of a compliance form and correlation with conflict styles. J Grad Med Educ. 2010;2(3):423‑9. https://doi.org/10.4300/JGME-D-10-00048.1

Engström M, Löfmark A, Vae KJU, Mårtensson G. Nursing students’ perceptions of using the Clinical Education Assessment tool AssCE and their overall perceptions of the clinical learning environment - A cross-sectional correlational study. Nurse Educ Today. 2017;51:63‑7. https://doi.org/10.1016/j.nedt.2017.01.009

Park YS, Zar FA, Norcini JJ, Tekian A. Competency evaluations in the next accreditation system: contributing to guidelines and implications. Teach Learn Med. 2016;28(2):135‑45. https://doi.org/10.1080/10401334.2016.1146607

Watson RS, Borgert AJ, O Heron CT, et al. A multicenter prospective comparison of the accreditation council for graduate medical education milestones: clinical competency committee vs. resident self-assessment. J Surg Educ. 2017;74(6):e8‑14. https://doi.org/10.1016/j.jsurg.2017.06.009

Ginsburg S, Regehr G, Lingard L, Eva KW. Reading between the lines: faculty interpretations of narrative evaluation comments. Med Educ. 2015;49(3):296‑306. https://doi.org/10.1111/medu.12637

Douglass KA, Jacquet GA, Hayward AS, et al. Development of a global health milestones tool for learners in emergency medicine: a pilot project. AEM Educ Train. 2017;1(4):269‑79. https://doi.org/10.1002/aet2.10046

Bartlett KW, Whicker SA, Bookman J, et al. Milestone-based assessments are superior to likert-type assessments in illustrating trainee progression. J Grad Med Educ. 2015;7(1):75‑80. https://doi.org/10.4300/JGME-D-14-00389.1

The Royal College of Physicians and Surgeons of Canada. CanMEDS Milestones. Ottawa (ON): The Royal College of Physicians and Surgeon of Canada; 2015. Available from: https://canmeds.royalcollege.ca/en/milestones

Marceau M, Gallagher F, Young M, St-Onge C. Validity as a social imperative for assessment in health professions education: a concept analysis. Med Educ. 2018;52(6):641‑53. https://doi.org/10.1111/medu.13574

American Educational Research Association., American Psychological Association., National Council on Measurement in Education., Joint Committee on Standards for Educational and Psychological Testing (U.S.). Standards for educational and psychological testing. Washington (DC): American Educational Research Association; 2014.

Gauthier G, St‐Onge C, Tavares W. Rater cognition: review and integration of research findings. Med Educ. 2016;50(5):511‑22. https://doi.org/10.1111/medu.12973

St-Onge C, Chamberland M, Lévesque A, Varpio L. Expectations, observations, and the cognitive processes that bind them: expert assessment of examinee performance. Adv Health Sci Educ. 2016;21:627‑42. https://doi.org/10.1007/s10459-015-9656-3

Govaerts M, van der Vleuten CPM. Validity in work‐based assessment: expanding our horizons. Med Educ. 2013;47(12):1164‑74. https://doi.org/10.1111/medu.12289

Kogan JR, Conforti L, Bernabeo E, Iobst W, Holmboe E. Opening the black box of clinical skills assessment via observation: a conceptual model. Med Educ. 2011;45(10):1048‑60. https://doi.org/10.1111/j.1365-2923.2011.04025.x

Yeates P, Cardell J, Byrne G, Eva KW. Relatively speaking: contrast effects influence assessors’ scores and narrative feedback. Med Educ. 2015;49(9):909‑19. https://doi.org/10.1111/medu.12777

Lee V, Brain K, Martin J. From opening the ‘black box’ to looking behind the curtain: cognition and context in assessor-based judgements. Adv Health Sci Educ. 2019;24:85‑102. https://doi.org/10.1007/s10459-018-9851-0

Pack R, Lingard L, Watling CJ, Chahine S, Cristancho SM. Some assembly required: tracing the interpretative work of Clinical Competency Committees. Med Educ. 2019;53(7):723‑34. https://doi.org/10.1111/medu.13884

Hauer KE, Cate O ten, Boscardin CK, et al. Ensuring resident competence: a narrative review of the literature on group decision making to inform the work of Clinical Competency Committees. J Grad Med Educ. 2016;8(2):156‑64. https://doi.org/10.4300/JGME-D-15-00144.1

Cheung WJ, Patey AM, Frank JR, Mackay M, Boet S. Barriers and enablers to direct observation of trainees’ clinical performance: a qualitative study using the theoretical domains framework. Acad Med. 2019;94(1):101‑14. https://doi.org/10.1097/ACM.0000000000002396

Watling C, LaDonna KA, Lingard L, Voyer S, Hatala R. ‘Sometimes the work just needs to be done’: socio‐cultural influences on direct observation in medical training. Med Educ. 2016;50(10):1054‑64. https://doi.org/10.1111/medu.13062

St-Onge C. Enjeux et défis de l’évaluation longitudinale: quelques pistes de réflexion préalables à son implantation. Pédagogie Médicale. 2018;19(3):137‑42. https://doi.org/10.1051/pmed/2019022

Madan R, Conn D, Dubo E, Voore P, Wiesenfeld L. The enablers and barriers to the use of direct observation of trainee clinical skills by supervising faculty in a psychiatry residency program. Can J Psychiatry. 2012;57(4):269‑72. https://doi.org/10.1177/070674371205700411

Kogan JR, Conforti LN, Yamazaki K, Iobst W, Holmboe ES. Commitment to change and challenges to implementing changes after workplace-based assessment rater training. Acad Med. 2017;92(3):394‑402. https://doi.org/10.1097/ACM.0000000000001319

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Influence of ecological conditions of various habitats on individual morpho-biological and physiological features of Hedysarum grandiflorum pall seeds

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L. D. Sajfutdinova , V. M. Kosolapov , V. I. Cherniavskih , E. V. Dumacheva; Influence of ecological conditions of various habitats on individual morpho-biological and physiological features of Hedysarum grandiflorum pall seeds. AIP Conf. Proc. 27 November 2023; 2929 (1): 040005. https://doi.org/10.1063/5.0179494

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New data have been obtained on the difference between morpho-biological and physiological characteristics and properties of H. grandiflorum seeds depending on the habitat of the parent plants. In 2009 and 2020, the dynamics of individual indicators of photosynthetic activity during the germination of H. grandiflorum indicates a certain relationship between the habitat conditions of the mother plant and the physiological state of germinating seeds. In seeds from CP 1 and CP 2, which were formed under conditions of limited ecotope resources, the intensity of photosynthesis, stomatal conductivity and the value of the A/Ci ratio were higher during germination, and the transpiration intensity was lower than during germination of CP 3 seeds. Correlation interactions of different strengths between individual indicators of photosynthesis and water exchange during seed germination have been established: a close negative relationship between the intensity of assimilation and the concentration of CO2 in the intercellular space (rs=-0.953 at P<0.05); weak positive relationship between assimilation intensity and stomatal conductivity for H 2 O (rs=0.326, P<0.05); close positive relationship between transpiration intensity and stomatal conductivity for H 2 O (rs=0.969, P<0.05); medium strength relationship between transpiration intensity and CO 2 assimilation intensity (rs=0.5367, P<0.05); weak negative between transpiration intensity and intercellular CO 2 concentration (rs= - 0.3301, P<0.05).

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Fall in uptake for funded mental health pharmacy training

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A total of 36 out of 70 (51%) places have been filled on a Health Education England (HEE)-funded mental health training programme for pharmacists running in 2024/2025, the University of Bradford has confirmed.

This is a fall from the previous year, when the university told The Pharmaceutical Journal that 39 out of 70 (55%) places were filled for the 2023/2024 cohort.

The ‘ Specialist mental health pharmacist training pathway ’ at the University of Bradford was launched in March 2022 to provide advanced training to pharmacists working in adult community mental health teams.

Following the first  intake of 50 pharmacists for the 2022/2023 cohort , HEE announced in February 2023 that the pathway would be  funded for a further two years , with 70 places available each year.

Traditionally, mental health pharmacists have mainly worked in secondary care, but the ‘ NHS Mental Health Implementation Plan 2019/2020 – 2023/2024 ‘, published in January 2019, set an ambition for 260 pharmacists to be employed in adult mental health community care settings by April 2024.

According to the University of Bradford’s registration page, the specialist training pathway aims to “empower pharmacists to safely deliver to the full scope of their professional capability and increase their competence in optimising medicines use for individuals with severe mental illness”. 

Commenting on the enrolment figures, a spokesperson for NHS England, which now includes HEE, told The Pharmaceutical Journal : “The numbers reflect the fact that pharmacy employers are still recruiting into these new roles. 

“For those that have, not all recruits require the training as some are already equipped with the necessary skills.”

The College of Mental Health Pharmacy (CMHP) works with the University of Bradford to accredit the training pathway.

Karen Shuker, president of the CMHP, told The Pharmaceutical Journal : “It is disappointing to see for the second year that the uptake of people undertaking this course is below the number of spaces available.”

She added that it was important that NHS England continued to provide funded training routes, such as the pathway at the University of Bradford, for mental health pharmacy training.

“NHS continuing professional development funding doesn’t include pharmacy teams, so there’s no protected money.

“If we don’t have access to training programmes funded by HEE, the only alternative is paid courses and people might find it difficult to access the appropriate funds,” Shuker said.

Diane Webb, assistant professor in pharmacy practice at the University of Bradford, said: “The University of Bradford programme lead and team welcomed cohort 3 students onto the training pathway at the end of March 2024 and we are ready for an inspirational year of learning.”

The Royal Pharmaceutical Society and CMHP published a draft curriculum to support advanced practice for mental health pharmacy in February 2024. It sets out the knowledge and skills needed to support highly complex patients, populations and health and social care systems, as well as improve the provision of mental health treatment. A consultation on the curriculum ended in March 2024.

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The Effect of COVID-19 on Education

Jacob hoofman.

a Wayne State University School of Medicine, 540 East Canfield, Detroit, MI 48201, USA

Elizabeth Secord

b Department of Pediatrics, Wayne Pediatrics, School of Medicine, Pediatrics Wayne State University, 400 Mack Avenue, Detroit, MI 48201, USA

COVID-19 has changed education for learners of all ages. Preliminary data project educational losses at many levels and verify the increased anxiety and depression associated with the changes, but there are not yet data on long-term outcomes. Guidance from oversight organizations regarding the safety and efficacy of new delivery modalities for education have been quickly forged. It is no surprise that the socioeconomic gaps and gaps for special learners have widened. The medical profession and other professions that teach by incrementally graduated internships are also severely affected and have had to make drastic changes.

• • Virtual learning has become a norm during COVID-19.
• • Children requiring special learning services, those living in poverty, and those speaking English as a second language have lost more from the pandemic educational changes.
• • For children with attention deficit disorder and no comorbidities, virtual learning has sometimes been advantageous.
• • Math learning scores are more likely to be affected than language arts scores by pandemic changes.
• • School meals, access to friends, and organized activities have also been lost with the closing of in-person school.

The transition to an online education during the coronavirus disease 2019 (COVID-19) pandemic may bring about adverse educational changes and adverse health consequences for children and young adult learners in grade school, middle school, high school, college, and professional schools. The effects may differ by age, maturity, and socioeconomic class. At this time, we have few data on outcomes, but many oversight organizations have tried to establish guidelines, expressed concerns, and extrapolated from previous experiences.

General educational losses and disparities

Many researchers are examining how the new environment affects learners’ mental, physical, and social health to help compensate for any losses incurred by this pandemic and to better prepare for future pandemics. There is a paucity of data at this juncture, but some investigators have extrapolated from earlier school shutdowns owing to hurricanes and other natural disasters. 1

Inclement weather closures are estimated in some studies to lower middle school math grades by 0.013 to 0.039 standard deviations and natural disaster closures by up to 0.10 standard deviation decreases in overall achievement scores. 2 The data from inclement weather closures did show a more significant decrease for children dependent on school meals, but generally the data were not stratified by socioeconomic differences. 3 , 4 Math scores are impacted overall more negatively by school absences than English language scores for all school closures. 4 , 5

The Northwest Evaluation Association is a global nonprofit organization that provides research-based assessments and professional development for educators. A team of researchers at Stanford University evaluated Northwest Evaluation Association test scores for students in 17 states and the District of Columbia in the Fall of 2020 and estimated that the average student had lost one-third of a year to a full year's worth of learning in reading, and about three-quarters of a year to more than 1 year in math since schools closed in March 2020. 5

With school shifted from traditional attendance at a school building to attendance via the Internet, families have come under new stressors. It is increasingly clear that families depended on schools for much more than math and reading. Shelter, food, health care, and social well-being are all part of what children and adolescents, as well as their parents or guardians, depend on schools to provide. 5 , 6

Many families have been impacted negatively by the loss of wages, leading to food insecurity and housing insecurity; some of loss this is a consequence of the need for parents to be at home with young children who cannot attend in-person school. 6 There is evidence that this economic instability is leading to an increase in depression and anxiety. 7 In 1 survey, 34.71% of parents reported behavioral problems in their children that they attributed to the pandemic and virtual schooling. 8

Children have been infected with and affected by coronavirus. In the United States, 93,605 students tested positive for COVID-19, and it was reported that 42% were Hispanic/Latino, 32% were non-Hispanic White, and 17% were non-Hispanic Black, emphasizing a disproportionate effect for children of color. 9 COVID infection itself is not the only issue that affects children’s health during the pandemic. School-based health care and school-based meals are lost when school goes virtual and children of lower socioeconomic class are more severely affected by these losses. Although some districts were able to deliver school meals, school-based health care is a primary source of health care for many children and has left some chronic conditions unchecked during the pandemic. 10

Many families report that the stress of the pandemic has led to a poorer diet in children with an increase in the consumption of sweet and fried foods. 11 , 12 Shelter at home orders and online education have led to fewer exercise opportunities. Research carried out by Ammar and colleagues 12 found that daily sitting had increased from 5 to 8 hours a day and binge eating, snacking, and the number of meals were all significantly increased owing to lockdown conditions and stay-at-home initiatives. There is growing evidence in both animal and human models that diets high in sugar and fat can play a detrimental role in cognition and should be of increased concern in light of the pandemic. 13

The family stress elicited by the COVID-19 shutdown is a particular concern because of compiled evidence that adverse life experiences at an early age are associated with an increased likelihood of mental health issues as an adult. 14 There is early evidence that children ages 6 to 18 years of age experienced a significant increase in their expression of “clinginess, irritability, and fear” during the early pandemic school shutdowns. 15 These emotions associated with anxiety may have a negative impact on the family unit, which was already stressed owing to the pandemic.

Another major concern is the length of isolation many children have had to endure since the pandemic began and what effects it might have on their ability to socialize. The school, for many children, is the agent for forming their social connections as well as where early social development occurs. 16 Noting that academic performance is also declining the pandemic may be creating a snowball effect, setting back children without access to resources from which they may never recover, even into adulthood.

Predictions from data analysis of school absenteeism, summer breaks, and natural disaster occurrences are imperfect for the current situation, but all indications are that we should not expect all children and adolescents to be affected equally. 4 , 5 Although some children and adolescents will likely suffer no long-term consequences, COVID-19 is expected to widen the already existing educational gap from socioeconomic differences, and children with learning differences are expected to suffer more losses than neurotypical children. 4 , 5

Special education and the COVID-19 pandemic

Although COVID-19 has affected all levels of education reception and delivery, children with special needs have been more profoundly impacted. Children in the United States who have special needs have legal protection for appropriate education by the Individuals with Disabilities Education Act and Section 504 of the Rehabilitation Act of 1973. 17 , 18 Collectively, this legislation is meant to allow for appropriate accommodations, services, modifications, and specialized academic instruction to ensure that “every child receives a free appropriate public education . . . in the least restrictive environment.” 17

Children with autism usually have applied behavioral analysis (ABA) as part of their individualized educational plan. ABA therapists for autism use a technique of discrete trial training that shapes and rewards incremental changes toward new behaviors. 19 Discrete trial training involves breaking behaviors into small steps and repetition of rewards for small advances in the steps toward those behaviors. It is an intensive one-on-one therapy that puts a child and therapist in close contact for many hours at a time, often 20 to 40 hours a week. This therapy works best when initiated at a young age in children with autism and is often initiated in the home. 19

Because ABA workers were considered essential workers from the early days of the pandemic, organizations providing this service had the responsibility and the freedom to develop safety protocols for delivery of this necessary service and did so in conjunction with certifying boards. 20

Early in the pandemic, there were interruptions in ABA followed by virtual visits, and finally by in-home therapy with COVID-19 isolation precautions. 21 Although the efficacy of virtual visits for ABA therapy would empirically seem to be inferior, there are few outcomes data available. The balance of safety versus efficacy quite early turned to in-home services with interruptions owing to illness and decreased therapist availability owing to the pandemic. 21 An overarching concern for children with autism is the possible loss of a window of opportunity to intervene early. Families of children and adolescents with autism spectrum disorder report increased stress compared with families of children with other disabilities before the pandemic, and during the pandemic this burden has increased with the added responsibility of monitoring in-home schooling. 20

Early data on virtual schooling children with attention deficit disorder (ADD) and attention deficit with hyperactivity (ADHD) shows that adolescents with ADD/ADHD found the switch to virtual learning more anxiety producing and more challenging than their peers. 22 However, according to a study in Ireland, younger children with ADD/ADHD and no other neurologic or psychiatric diagnoses who were stable on medication tended to report less anxiety with at-home schooling and their parents and caregivers reported improved behavior during the pandemic. 23 An unexpected benefit of shelter in home versus shelter in place may be to identify these stressors in face-to-face school for children with ADD/ADHD. If children with ADD/ADHD had an additional diagnosis of autism or depression, they reported increased anxiety with the school shutdown. 23 , 24

Much of the available literature is anticipatory guidance for in-home schooling of children with disabilities rather than data about schooling during the pandemic. The American Academy of Pediatrics published guidance advising that, because 70% of students with ADHD have other conditions, such as learning differences, oppositional defiant disorder, or depression, they may have very different responses to in home schooling which are a result of the non-ADHD diagnosis, for example, refusal to attempt work for children with oppositional defiant disorder, severe anxiety for those with depression and or anxiety disorders, and anxiety and perseveration for children with autism. 25 Children and families already stressed with learning differences have had substantial challenges during the COVID-19 school closures.

High school, depression, and COVID-19

High schoolers have lost a great deal during this pandemic. What should have been a time of establishing more independence has been hampered by shelter-in-place recommendations. Graduations, proms, athletic events, college visits, and many other social and educational events have been altered or lost and cannot be recaptured.

Adolescents reported higher rates of depression and anxiety associated with the pandemic, and in 1 study 14.4% of teenagers report post-traumatic stress disorder, whereas 40.4% report having depression and anxiety. 26 In another survey adolescent boys reported a significant decrease in life satisfaction from 92% before COVID to 72% during lockdown conditions. For adolescent girls, the decrease in life satisfaction was from 81% before COVID to 62% during the pandemic, with the oldest teenage girls reporting the lowest life satisfaction values during COVID-19 restrictions. 27 During the school shutdown for COVID-19, 21% of boys and 27% of girls reported an increase in family arguments. 26 Combine all of these reports with decreasing access to mental health services owing to pandemic restrictions and it becomes a complicated matter for parents to address their children's mental health needs as well as their educational needs. 28

A study conducted in Norway measured aspects of socialization and mood changes in adolescents during the pandemic. The opportunity for prosocial action was rated on a scale of 1 (not at all) to 6 (very much) based on how well certain phrases applied to them, for example, “I comforted a friend yesterday,” “Yesterday I did my best to care for a friend,” and “Yesterday I sent a message to a friend.” They also ranked mood by rating items on a scale of 1 (not at all) to 5 (very well) as items reflected their mood. 29 They found that adolescents showed an overall decrease in empathic concern and opportunity for prosocial actions, as well as a decrease in mood ratings during the pandemic. 29

A survey of 24,155 residents of Michigan projected an escalation of suicide risk for lesbian, gay, bisexual, transgender youth as well as those youth questioning their sexual orientation (LGBTQ) associated with increased social isolation. There was also a 66% increase in domestic violence for LGBTQ youth during shelter in place. 30 LGBTQ youth are yet another example of those already at increased risk having disproportionate effects of the pandemic.

Increased social media use during COVID-19, along with traditional forms of education moving to digital platforms, has led to the majority of adolescents spending significantly more time in front of screens. Excessive screen time is well-known to be associated with poor sleep, sedentary habits, mental health problems, and physical health issues. 31 With decreased access to physical activity, especially in crowded inner-city areas, and increased dependence on screen time for schooling, it is more difficult to craft easy solutions to the screen time issue.

During these times, it is more important than ever for pediatricians to check in on the mental health of patients with queries about how school is going, how patients are keeping contact with peers, and how are they processing social issues related to violence. Queries to families about the need for assistance with food insecurity, housing insecurity, and access to mental health services are necessary during this time of public emergency.

Medical school and COVID-19

Although medical school is an adult schooling experience, it affects not only the medical profession and our junior colleagues, but, by extrapolation, all education that requires hands-on experience or interning, and has been included for those reasons.

In the new COVID-19 era, medical schools have been forced to make drastic and quick changes to multiple levels of their curriculum to ensure both student and patient safety during the pandemic. Students entering their clinical rotations have had the most drastic alteration to their experience.

COVID-19 has led to some of the same changes high schools and colleges have adopted, specifically, replacement of large in-person lectures with small group activities small group discussion and virtual lectures. 32 The transition to an online format for medical education has been rapid and impacted both students and faculty. 33 , 34 In a survey by Singh and colleagues, 33 of the 192 students reporting 43.9% found online lectures to be poorer than physical classrooms during the pandemic. In another report by Shahrvini and colleagues, 35 of 104 students surveyed, 74.5% students felt disconnected from their medical school and their peers and 43.3% felt that they were unprepared for their clerkships. Although there are no pre-COVID-19 data for comparison, it is expected that the COVID-19 changes will lead to increased insecurity and feelings of poor preparation for clinical work.

Gross anatomy is a well-established tradition within the medical school curriculum and one that is conducted almost entirely in person and in close quarters around a cadaver. Harmon and colleagues 36 surveyed 67 gross anatomy educators and found that 8% were still holding in-person sessions and 34 ± 43% transitioned to using cadaver images and dissecting videos that could be accessed through the Internet.

Many third- and fourth-year medical students have seen periods of cancellation for clinical rotations and supplementation with online learning, telemedicine, or virtual rounds owing to the COVID-19 pandemic. 37 A study from Shahrvini and colleagues 38 found that an unofficial document from Reddit (a widely used social network platform with a subgroup for medical students and residents) reported that 75% of medical schools had canceled clinical activities for third- and fourth-year students for some part of 2020. In another survey by Harries and colleagues, 39 of the 741 students who responded, 93.7% were not involved in clinical rotations with in-person patient contact. The reactions of students varied, with 75.8% admitting to agreeing with the decision, 34.7% feeling guilty, and 27.0% feeling relieved. 39 In the same survey, 74.7% of students felt that their medical education had been disrupted, 84.1% said they felt increased anxiety, and 83.4% would accept the risk of COVID-19 infection if they were able to return to the clinical setting. 39

Since the start of the pandemic, medical schools have had to find new and innovative ways to continue teaching and exposing students to clinical settings. The use of electronic conferencing services has been critical to continuing education. One approach has been to turn to online applications like Google Hangouts, which come at no cost and offer a wide variety of tools to form an integrative learning environment. 32 , 37 , 40 Schools have also adopted a hybrid model of teaching where lectures can be prerecorded then viewed by the student asynchronously on their own time followed by live virtual lectures where faculty can offer question-and-answer sessions related to the material. By offering this new format, students have been given more flexibility in terms of creating a schedule that suits their needs and may decrease stress. 37

Although these changes can be a hurdle to students and faculty, it might prove to be beneficial for the future of medical training in some ways. Telemedicine is a growing field, and the American Medical Association and other programs have endorsed its value. 41 Telemedicine visits can still be used to take a history, conduct a basic visual physical examination, and build rapport, as well as performing other aspects of the clinical examination during a pandemic, and will continue to be useful for patients unable to attend regular visits at remote locations. Learning effectively now how to communicate professionally and carry out telemedicine visits may better prepare students for a future where telemedicine is an expectation and allow students to learn the limitations as well as the advantages of this modality. 41

Pandemic changes have strongly impacted the process of college applications, medical school applications, and residency applications. 32 For US medical residencies, 72% of applicants will, if the pattern from 2016 to 2019 continues, move between states or countries. 42 This level of movement is increasingly dangerous given the spread of COVID-19 and the lack of currently accepted procedures to carry out such a mass migration safely. The same follows for medical schools and universities.

We need to accept and prepare for the fact that medial students as well as other learners who require in-person training may lack some skills when they enter their profession. These skills will have to be acquired during a later phase of training. We may have less skilled entry-level resident physicians and nurses in our hospitals and in other clinical professions as well.

The COVID-19 pandemic has affected and will continue to affect the delivery of knowledge and skills at all levels of education. Although many children and adult learners will likely compensate for this interruption of traditional educational services and adapt to new modalities, some will struggle. The widening of the gap for those whose families cannot absorb the teaching and supervision of education required for in-home education because they lack the time and skills necessary are not addressed currently. The gap for those already at a disadvantage because of socioeconomic class, language, and special needs are most severely affected by the COVID-19 pandemic school closures and will have the hardest time compensating. As pediatricians, it is critical that we continue to check in with our young patients about how they are coping and what assistance we can guide them toward in our communities.

Clinics care points

• • Learners and educators at all levels of education have been affected by COVID-19 restrictions with rapid adaptations to virtual learning platforms.
• • The impact of COVID-19 on learners is not evenly distributed and children of racial minorities, those who live in poverty, those requiring special education, and children who speak English as a second language are more negatively affected by the need for remote learning.
• • Math scores are more impacted than language arts scores by previous school closures and thus far by these shutdowns for COVID-19.
• • Anxiety and depression have increased in children and particularly in adolescents as a result of COVID-19 itself and as a consequence of school changes.
• • Pediatricians should regularly screen for unmet needs in their patients during the pandemic, such as food insecurity with the loss of school meals, an inability to adapt to remote learning and increased computer time, and heightened anxiety and depression as results of school changes.

The authors have nothing to disclose.

Biologically active lignans in extract and seeds of Schizandra chinensis

• Published: February 2007
• Volume 41 , pages 94–96, ( 2007 )

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• E. N. Zhukovich 1 ,
• S. Yu. Bokareva 1 ,
• L. A. Sharikova 1 ,
• T. F. Pribytkova 1 ,
• M. Yu. Semenova 1 &
• L. M. Korovina 1  

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A method for standardization of Schisandra chinensis has been developed, which is based on the isolation of the pure lignan fraction with the major content of schizandrol A followed by quantitative spectrophotometric assay with reference to a reliable standard. Solutions used for the primary assay were concentrated and studied by TLC (qualitative analysis). It is established that the content of pure lignans in the S. chinensis extract varies within 0.1–0.2%. Exhaustive extraction with a sequence of solvents showed that air-dry seeds of S. chinensis contain about 1% of pure lignan fraction (predominantly schizandrol A). HPLC analyses showed that the content of schizandrol A in the extract amounted to 0.088% (about 45% of the total purified lignan fraction) and reaches 0.7% in the seeds (about 70% of the purified lignan fraction).

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V. V. Berdyshev, Valeologiya , No. 2, 105–117 (1995).

K. M. Ko, S. P. Ip, M. K. Poon, et al., Planta Med. , 61 (2), 134–137 (1995).

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X. F. Wu, H. Chen, Z. R. Zhao, Zhongguo Zhong Yao Za Zhi , 28 (1), 39–40, 72 (2003).

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Guide to Methods of Quality and Safety Control for Biologically Active Food Additives (State Sanitary and Epidemiology Inspection Document No. R4.1.1672-03) [in Russian], Ministry of Public Health, Moscow (2004).

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E. N. Zhukovich, S. Yu. Bokareva, L. A. Sharikova, T. F. Pribytkova, M. Yu. Semenova & L. M. Korovina

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Translated from Khimiko-Farmatsevticheskii Zhurnal, Vol. 41, No. 2, pp. 35–37, February, 2007.

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Zhukovich, E.N., Bokareva, S.Y., Sharikova, L.A. et al. Biologically active lignans in extract and seeds of Schizandra chinensis . Pharm Chem J 41 , 94–96 (2007). https://doi.org/10.1007/s11094-007-0020-7

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Iowa lawmakers address immigration, religious freedom and taxes in 2024 session

FILE - The Iowa Capitol is visible before sunrise, Jan. 12, 2024, in Des Moines, Iowa. After a marathon day that stretched into the early hours of Saturday, April 20, Iowa lawmakers wrapped up a four-month legislative session that was focused on reforming the way special education is managed and speeding up tax cuts. (AP Photo/Andrew Harnik, File)

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DES MOINES, Iowa (AP) — After a marathon day that stretched into Saturday’s early hours, Iowa lawmakers wrapped up a four-month legislative session that focused on reforming the way special education is managed and speeding up tax cuts. The Republican-led General Assembly also waded into issues like immigration and religious freedom , which have proven core to the party’s 2024 campaign message.

Gov. Kim Reynolds, a Republican, pushed many priorities through the Legislature after submitting 18 requests for bill drafts, more than any other year of her tenure and any other governor since 2006, publicly available data shows.

Here’s a look at the issues that made headlines:

REYNOLDS’ PRIORITIES DOMINATE SESSION

Education was a key issue for Reynolds this session, including one proposal to revise the state’s education system for students with disabilities that consumed lawmakers’ attention.

Reynolds wanted school districts to be able to choose how to use their special education dollars. For decades, those funds have gone directly to cooperatives known as area education agencies, or AEAs, that provide special education services.

A compromise lets schools choose, starting in 2025, how to spend 10% of their special education funding. But that approach, along with other changes in the final bill, still leaves many disability advocates and AEA staff concerned that the agencies and special education will suffer.

MORE ON EDUCATION

Lawmakers also approved an increased minimum salary for Iowa teachers. In the upcoming school year, teachers with less than 12 years of experience will earn at least $47,500, up from $33,500. The minimum salary for more experienced teachers rises to $60,000. Both figures will increase again in the following school year.

The law also addressed non-salaried teachers and staff, allocating $14 million to help schools raise supplemental teacher pay.

In the final days of the session, lawmakers passed provisions to restrict programs related to diversity, equity and inclusion, or DEI, at the state’s public universities, joining a wave of Republican-led states weighing in on the initiatives. The bill prohibits staff positions and offices dedicated to creating or promoting DEI policies, programming or training, except as otherwise required by federal regulations.

IMMIGRATION LAW

Iowa Republicans followed Texas’ footsteps by passing a bill making it a state crime for a person to be in Iowa if previously denied admission to or removed from the United States. Reynolds signed it into law on April 10.

In Iowa and across the country , Republican leaders have accused President Joe Biden of neglecting his responsibilities to enforce federal immigration law.

The Iowa law, which takes effect July 1, has elevated anxiety in Iowa’s immigrant communities and has prompted questions among legal experts and law enforcement on how it will be enforced. It mirrors part of a Texas law that is currently blocked in court. The Justice Department has argued that such state laws are a clear violation of federal authority.

PREGNANCY BILLS

A bill passed this year updated an existing program that funds nonprofits known as crisis pregnancy centers, typically nonmedical facilities that counsel clients against having an abortion, charging the state’s health agency with implementation after it had difficulty finding a third-party administrator.

A separate budget bill provides an additional $1 million in funding for the program.

Lawmakers, with Reynolds’ recommendation, also expanded maternity leave from 60 days to 12 months for the state’s lowest-income moms on Medicaid.

Iowa Democrats, who have proposed expanded Medicaid maternity leave in the past, said the bill would remove benefits for certain mothers who did not meet the lower income threshold.

RELIGIOUS FREEDOM

Iowa joined about two dozen other states by enacting an echo of the Religious Freedom Restoration Act, a 1993 federal law that said government would not be able to “substantially burden” someone’s constitutional right to freedom of religion.

Republicans argued that religious freedom is under attack, so the state’s code needed to further enshrine those rights, while Democrats said it would allow some people’s religious beliefs to justify discrimination.

Republican lawmakers voted to speed up the state’s 2022 income tax cuts, instituting a 3.8% flat income tax rate beginning next year.

Republicans also took the first steps toward two tax-related constitutional amendments to put before Iowa voters. One would enshrine the state’s use of a single rate for income taxes, and the other would require a two-thirds majority of lawmakers to change the tax code. To put a constitutional amendment on the ballot, Iowa lawmakers have to approve it in two consecutive sessions, so both resolutions would have to pass again in 2025 or 2026 to make the ballot.

WHAT DIDN’T SUCCEED

Lawmakers rejected one bill that would have removed gender identity from the state’s civil right law and another that would have narrowly defined male and female. The latter, requested by Reynolds, would have required a transgender person’s assigned sex at birth to be listed alongside their gender identity on their birth certificate.

House Republicans failed to advance a Senate-approved bill proposed by chemical giant Bayer that would have given the company legal protections against claims it failed to warn that its popular pesticide Roundup causes cancer, if the company is otherwise in compliance with federal regulations. One House Republican, a farmer, said he’ll put his name on it next year to try to see it through.

Iowa lawmakers also did not put forth a ballot initiative declaring there is no constitutional right to abortion in the state — after initially advancing the measure in 2021. Reynolds has said she’ll let the issue move through the courts rather than push for a vote. Iowa’s current law banning most abortions after roughly six weeks , before many women know they are pregnant, was enacted in July but paused by a judge soon after. The state Supreme Court will weigh in on the case in June.

A bill that would have made changes to Iowa’s fetal homicide law was shelved after a Senate Republican joined Democrats in voicing concerns about the potential impact on in vitro fertilization following an Alabama court ruling that frozen embryos can be considered children. Iowa’s law currently outlines penalties for terminating or seriously injuring a “human pregnancy.” The House-approved bill would have changed that language to apply to the death of, or serious injury to, an “unborn person” from fertilization to live birth.