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A slow but significant change has been taking place in the early reading world over the past year, loosening the grip that some long-used, but unproven, instructional techniques have held over the field for decades.
Big names—like Lucy Calkins, of the Teachers College Reading and Writing Project, and author and literacy specialist Jennifer Serravallo—have recently released updates to their published materials or announced impending rewrites that change how they instruct students to decipher words.
Reading researchers say they find these industry moves encouraging. “The fact that there’s an awareness … that’s a step in the right direction,” said Claude Goldenberg, a professor emeritus at Stanford University who studies early literacy development in English-language learners.
But they also cautioned that this narrow change in materials won’t necessarily lead to large shifts in instructional practice, and that more needs to be done to support teachers of the youngest learners in developing kids’ early reading skills—especially after several years of disrupted, pandemic-era schooling.
The shifts curriculum providers are making mainly have to do with how teachers instruct students in word-level reading—that is, decoding the words on the page into spoken language.
Much of teacher training and many classroom materials adhere to the theory that children should use multiple sources of information, or cues—the letters in a word, but also the pictures on the page or the flow of the sentence—to make a prediction about what the word is.
But evidence from cognitive psychology and neuroscience research has long shown that good readers attend to the letters in the words to identify what words say. Research has demonstrated that instructing students on how to crack the code of written language is one of the most effective ways to get them reading words.
And while it’s important to teach young kids about story structure and syntax, and to have rich conversations about illustrations in picture books, children shouldn’t rely on those sources of information to guess at what the words on the page say, said Goldenberg.
“There’s a very subtle, nuanced, delicate dance in sequencing,” he said. “It’s that kind of delicate balance that I see completely missing from programs that try to do everything all at once.”
Now, some publishers are trying to make a shift in how they integrate, sequence, and attend to foundational skills instruction. But there are open questions about how these changes in materials will change practice in classrooms.
“We see ourselves at a hinge moment,” said Maryanne Wolf, the director of the Center for Dyslexia, Diverse Learners, and Social Justice at the UCLA School of Education and Information Studies, and the author of several seminal books about how the brain learns to read. “The separation of two doors on reading has been not just unfortunate, but even tragic, leaving behind children who have needed desperately a different form of instruction.”
A public conversation about reading science led to materials changes
The research motivating these changes isn’t new.
In 2000, a panel of experts was convened by the federal government to evaluate the evidence on reading instruction. One of the takeaways from the National Reading Panel’s report was that explicitly teaching about the sounds in words, and how those sounds matched up to written letters, would help children learn to read. This finding drove policy changes in the early 2000s, most notably the introduction of Reading First, a federally funded program that emphasized phonemic awareness and phonics instruction.
The program had mixed results, leading to some improvements in children’s word-reading ability, but not in their reading comprehension. In its wake, many schools and teacher education programs adopted a model called balanced literacy—aiming to balance foundational skills instruction with more focus on stories, comprehension, and developing a love of reading.
But in 2018, reporter Emily Hanford of APM Reports brought to light that in many balanced literacy classrooms, students were not receiving systematic, explicit instruction in phonics—how written letters match up to spoken sounds—and were being encouraged to use other strategies to guess at words. Without this foundational instruction, many students never figure out how to decode the printed words on the page.
Hanford’s documentaries—as well as a slew of coverage from Education Week and other outlets—ignited a firestorm of controversy, with some teachers outraged that they had never learned how to teach phonics in their teacher preparation programs, and others pushing back with a defense of their teaching methods. In the several years that followed, more states started to mandate teacher training in, and classroom attention to, foundational skills instruction in an effort to adhere to what came to be referred to as the “science of reading.”
But these word-guessing strategies are also deeply embedded in much of early reading curricula, as Education Week reporting has shown. Many programs and teacher guides encourage prompting students to rely on a story’s meaning and structure, as well as the letters on the page, to predict what words will say—a strategy known as three-cueing or MSV (for meaning, structure, and visual). And while most curricula incorporate phonics instruction, it’s often “competing for teachers’ and children’s attention and time,” said Goldenberg.
Now, some influential publishers are starting to make changes.
This summer, Serravallo released an update to part of her popular The Reading Strategies Book, revising strategies for word-level reading to emphasize decoding and abandoning techniques that encourage students to guess at words. Early this year, literacy consultants Jan Burkins and Kari Yates released a new book, Shifting the Balance, that offers “ways to bring the science of reading into the balanced literacy classroom.”
And Calkins, of the Teachers College Reading and Writing Project, has announced upcoming revisions to her popular Units of Study for Teaching Reading program. The changes, Calkins said, will incorporate more explicit instruction in phonics and remove some prompts that ask students to look to pictures or context for word identification.
I think teachers want to learn, and … I can model that it’s OK to say, ‘There were a few things I think I got wrong, and I’m learning about them.’
Lucy Calkins, director of the Teachers College Reading and Writing Project
At the same time, several more states have passed laws mandating that schools teach the “science of reading”—laws that would affect curricula and materials.
Mark Seidenberg, a cognitive scientist at the University of Wisconsin-Madison who studies reading, said the publishers’ changes are a response to these new policy priorities. But he worries that the revisions will be surface level, only shifting instruction enough to “satisfy the stipulations in those laws,” he said.
“They can’t change their materials too much, because they’ll lose their followers,” Seidenberg said. “What’s going to come out of this? Minimal changes that are enough to satisfy [these] states.”
Wiley Blevins, an educational consultant and author of several books on phonics teaching, understands the critiques, and the skepticism, that some experts are expressing about these changes: “I get the anger, because we’re talking about kids’ lives. We’re talking about their futures.” But he sees more reason for optimism, in teachers who may now have more guidance to “do better for their students.”
Lucy Calkins outlines upcoming changes to Units of Study
In some cases, this guidance for teachers is still forthcoming. Calkins’ Reading and Writing Project, a workshop-based program that publishes a reading curriculum used by about 16 percent of early elementary and special education teachers, according to data gathered by Education Week, is planning to release updated materials in summer 2022. (The timeline has been pushed back due to COVID-related production delays, Calkins said.)
The planned update reflects a shift in approach for the group. In November 2019, Calkins released a statement pushing back on those whom she described as “the phonics-centric people who are calling themselves ‘the science of reading.’” About a year later, in fall 2020, TCRWP put out a new position statement, calling for attention to phonemic awareness and phonics instruction, and emphasizing that sounding out words is the best strategy for kids to use to figure out what those words say.
“[P]oring over the work of contemporary reading researchers has led us to believe that aspects of balanced literacy need some ‘rebalancing,’” the document read.
The revised units will offer different guidance on reading “superpowers,” or reading strategies, Calkins said. Instead of being taught “picture power”—to look at the pictures to figure out words—students will be taught “slider power,” that they should “slide” over the word to blend the letter sounds together. Early units will also teach a progression of letter sounds and explicitly address how to decode short, phonetically regular words, Calkins said.
Students will still learn “picture power” later, she added, but as a comprehension strategy for understanding the meaning of the story, rather than as a strategy to identify words.
TCRWP will also release new decodable books that include sound-spelling patterns that children learn, so that students can practice applying their phonics knowledge to texts. (Studies have shown that using decodable books can encourage students to try to sound out words while they’re reading.) The group will recommend that teachers integrate these alongside their predictable books, which have repetitive sentence structures and pictures that give clues as to the words on the page. The earliest kindergarten units, which Calkins calls “pre-reading units,” still use predictable books to teach concepts of print and high-frequency words.
Though Calkins says that these changes are “not small,” she also maintains that much of reading workshop will remain the same. “There’s a trademark to our schools that are working with us. There’s a trademark tone to the classrooms. Kids collaborating deeply, passionate about books, talking all the time about their ideas about books, writing up a storm,” she said.
“I don’t think the teachers will find [these changes] jarring,” she continued. ”I think teachers want to learn, and … I can model that it’s OK to say, ‘There were a few things I think I got wrong, and I’m learning about them.’”
Goldenberg, who was one of the researchers who participated in an external review of the Units of Study in Reading published in early 2020, said that many of the lessons in the current curriculum are well done, but that they’re “sitting on a flimsy foundation.”
Layering on more attention to the foundations of reading could strengthen the program, but only if this focus is deeply and purposefully embedded, he said.
New teacher guides rethink old practices
Other authors have already released updates into the marketplace, like Burkins and Yates, who have written teacher guides on reading coaching, balanced literacy, and guided reading.
When Hanford’s work first came out, Burkins said, her colleagues in the field were on the defensive—and she and Yates, were, too.
“I’m going to own that I had defensiveness, dismissiveness, uncertainty about why some of these claims seemed outlandish or wrong,” Yates said.
While Burkins had read the work of a few cognitive psychologists in her training, much of the body of research that Hanford drew from was unfamiliar to her. “If you’re an educator, your information inputs have not been from the cognitive [research] side,” she said. Even in her doctoral program, where she completed a dissertation on phonemic awareness research, research courses were limited and she felt that she received mixed messages about evidence-based practice.
Burkins approached Yates about exploring the research together. “Jan really said, ‘Kari, we’ve got to take a deep dive into this because, look—we’ve built careers around supporting early literacy. And we have coached teachers on many of the practices that are being criticized,’” Yates said. “And so I think part of it, for us, was: We know we owe it to the people we’re trying to serve—who are not just children, they’re teachers—to figure out what’s amiss here.”
The book outlines six “shifts” in thinking for the balanced literacy classroom: rethinking how comprehension begins, committing to phonemic awareness instruction, reimagining phonics teaching, revising instruction on high-frequency words, rethinking MSV, and reconsidering which texts beginning readers should read.
The focus, Burkins and Yates said, was on making the research that has appeared in journals accessible and actionable for teachers. They also tried to highlight where practices that many teachers already use align with evidence-based best practice—like engaging students in rich read-alouds, or using text sets of books that approach one topic from different angles to build knowledge.
“When you come in with the approach of, shut all this down and start fresh, you’re going to lose teachers. Energy is our most precious resource,” said Yates. “This work is as much about the reading science as it is about the science of understanding how to support human and organizational change.”
Like Burkins and Yates, Serravallo, the author of The Reading Strategies Book, also noted the inaccessibility of paywalled journals. More recently published books, like Seidenberg’s Language at the Speed of Sight, Daniel Willingham’s The Reading Mind, and Wolf’s Reader, Come Home “make it easier for people to find the information,” she said.
Serravallo worked with several reading researchers, including Wolf, on the updates to her book. Wolf, who met Serravallo while they were recording a podcast together for Serravallo’s publisher Heinemann, said that they were able to find common ground in a shared vision of what reading instruction should ultimately do.
“She knew that my particular goal, my ultimate goal … is deep reading,” Wolf said. “Deep reading is when the brain has gone well beyond that first decoding brain, and into a place where all the parts are working automatically enough and connected to each other so that time can be allocated to critical thinking, inference, empathy, reflection. All of these are the real goals for a society.”
Strong instruction in foundational skills is just one piece, but a fundamental piece, of achieving that vision, Wolf said.
This work is as much about the reading science as it is about the science of understanding how to support human and organizational change.
Kari Yates, co-author of ‘Shifting the Balance: 6 Ways to Bring the Science of Reading into the Balanced Literacy Classroom’
Serravallo’s revision is an overhaul of chapter 3 of The Reading Strategies Book (the book is designed to help teachers work with students, but it’s not a curriculum). The chapter focuses on strategies for deciphering words. The old version starts, “In order to construct accurate meaning from a text, children need to read words correctly, integrating three sources of information: meaning, syntax, and visual.”
The new version takes an entirely different approach, explaining the different ways a child can decode a word, and noting that the goal of orthographic mapping—”gluing” the spelling and the sound together in memory, so the word can be retrieved automatically.
Gone are the recommendations that children guess at the word based on the pictures or the rest of the sentence; in their place are suggestions for helping students apply their phonics knowledge to word reading. The new version also cites different sources, from a body of research in developmental psychology and cognitive science that wasn’t referenced in the original.
“The common practice that I used, and that my colleagues used, back when I wrote that [original] chapter relied on a certain type of text that scaffolds kids’ early reading by providing a lot of exposure to high-frequency words, some decoding, and some use of meaning to decipher the words on the page,” said Serravallo.
For some children, she said, the combination was enough to get them started on a path to fluent reading. “For other kids, it is a problem,” she said.
Reading community calls for more work translating research to practice
Seidenberg said the changes in Serravallo’s book, in particular, could prove a useful resource for classroom teachers. But he worries about a framework for reading instruction that is still oriented around “strategies,” focusing on how to respond to struggle.
For example, he said: “If the kid understands that there are digraphs, and has had enough relevant practice with them, you shouldn’t have to have a backup strategy [for recognizing digraphs].”
But Sandra Maddox, a literacy specialist with the South Carolina Department of Education, who consulted Serravallo on the revisions to her book, said that the classroom context isn’t always so predictable. Some students might be able to apply the new phonics skills they learn right away; others need more repetition and targeted reminders. “It’s not enough to just say, ‘sound it out,’” said Maddox, who specializes in working with children with dyslexia.
Reading researchers, publishers, and educators alike all voiced a need for more translational work—collaborations between cognitive psychologists and educators to implement reading science in ways that are effective and practical.
Understanding reading research is one thing; applying it is another, said Yates. “Knowing how the brain learns to read does not answer the question that a kindergarten teacher [asks], in those 4,000-plus decisions they make every day, about exactly how to proceed with this group of kids in front of them,” she said.
Wolf said that her team at UCLA is “busily building bridges.” They’re working within the school of education, teaching teachers about dyslexia, while also collaborating with neurologists at the University of California San Francisco. “We are really determined to pull neuroscience and education together, for the benefit of all,” she said.
Other researchers, too, are working on local efforts: In Madison, for example, Seidenberg sat on an early literacy task force with leaders from the Madison Metropolitan school district and the University of Wisconsin-Madison School of Education, with the goal of improving student reading outcomes and closing opportunity gaps.
This kind of work is happening slowly, Wolf said.
It’s hard to know, yet, what effect these publishing changes will have
Maddox has already seen some uptake of Serravallo’s new pages among the teachers she works with. “They’re downloading them, printing them out, and adding them to their book,” she said. “What I hope it does is make teachers more aware of the strategies for decoding, and make them more aware of phonemic awareness and phonics in general.”
This knowledge is more necessary this year than ever, said Blevins, who consults with school districts. Because of educational disruptions during the pandemic, he said, teachers in older elementary grades are seeing large numbers of students with foundational skills gaps—in some cases, for the first time.
“They don’t even know where to start. [The teachers have] never heard of blending,” he said. He’s started doing sessions with 3rd, 4th, and 5th grade teachers in addition to the earlier elementary teachers he normally works with, teaching them a handful of key routines they can use and introducing them to a comprehensive phonics survey they can give kids to figure out what skills they need to focus on.
“I think that there’s a recognition that upper grade teachers need more knowledge of phonics,” said Calkins. “Third graders, the last time they had an uninterrupted year in school was kindergarten.”
But researchers say there are still barriers in schools to identifying student needs. “I do think the measurement groups have been slower to respond than some of the instructional ones,” Matthew Burns, a professor of special education in the University of Missouri’s College of Education and Human Development, said of common classroom tools used to take reading inventories, evaluating what students know and don’t know.
In a study on publisher Fountas and Pinnell’s reading inventory, Burns and his colleagues found that the results weren’t reliable: Students would receive different scores with different books that were supposedly both at their reading level. “We put too much stock in the score we get from these measures,” he said.
Fountas and Pinnell materials, which include reading curricula as well as assessment tools, use many of the word-guessing strategies that other publishers are starting to move away from. The group’s founders, Irene Fountas and Gay Su Pinnell, declined to comment for this story through their publisher, Heinemann.
However, in a Sept. 8 opinion piece for Education Week, Fountas and Pinnell distanced themselves from the term “balanced literacy,” and characterized the ongoing conversation about reading practice as the “latest chapter in the reading wars.”
“We believe this round of conflict, like the previous ones, is harmful to our profession and has real potential for confusing children as well as teachers and administrators,” they wrote.
Fountas and Pinnell’s intervention materials, Leveled Literacy Intervention, hold a large share of the market—43 percent of early elementary and special education teachers said they used LLI in a 2019 Education Week survey.
Changes to materials would better support teachers, Blevins said. But he stressed that stamping a “science of reading” approved seal on a resource and putting it in teachers’ hands doesn’t necessarily give teachers the knowledge and understanding they need to change their instruction.
“Whenever you see these shifts happening, it’s always surface knowledge,” Blevins said. “What that has boiled down to is … on social media, teachers will name a program and say, ‘Is this science of reading?’”
The overwhelming interest in reading research presents an opportunity, and a caution, Blevins said. “It is a moment that if we did it right, we could take advantage of it and help millions of kids. But we need to go deeper.”
MONTGOMERY – Nicole Borrico had constantly wanted to homeschool her kids. COVID gave her the drive.
“It’s a lot a lot easier than you think it is. The best detail about homeschooling is you get to educate your little ones what they’re fascinated in,” Borrico said. “You learn through experience and you are a lot more arms-on.”
With contact tracing and other COVID principles in put, Borrico pulled her 10-year-outdated daughter out of a public school last year because she felt extra comfy to teach her at household. This year she homeschools her child for the second 12 months in a row as she does not want to be concerned about the likely of schooling becoming disrupted by exposure-related school closures.
The pandemic led to homeschool surges across the state. Previous spring, about 5.4{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of all U.S. homes with school-aged children have been homeschooling and the determine rose to 11{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} by previous drop, according to a U.S. Census Bureau report. Before the pandemic, residence homeschooling fees had remained continual at all around 3.3{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} through the previous a number of yrs.
As schools have opened for total-time classroom mastering this school yr, some parents selected to continue on homeschooling. Flexibility, unique awareness, fingers-on studying experiences and shut bonding involving mothers and fathers and children are among the the reasons that they homeschool for a 2nd year in a row.
Like a lot of homeschooling mothers and fathers, Borrico needs to discover a way to equilibrium tutorial, additional-curricular activities and social-emotional needs. As for her daughter, who has learned horseback driving for four years, Borrico states it is a wonderful way to get bodily education and learning even though creating up confidence.
Borrico is just one of dozens of moms and dads who requested a new horseback-riding program specifically geared towards homeschoolers at Hollow Hill Farm in Montgomery.
Beth Zylstra, proprietor of Hollow Hill Farm, said she started a new specialized program for homeschoolers in September and modified the system material to meet their needs. The plan is made up of four 1.5-hour weekly sessions, which incorporate using instruction, artwork, crafts and games. She has taught nearly 40 homeschoolers since then. In reaction to the uptick in demand, she has expanded the facility with an more ground and four stalls this yr.
“It’s a big achievement. The youngsters actually love coming to the farm, currently being about the horses and finding out new points,” said Zylstra. “I consider they like acquiring out and viewing other youngsters at their age, who share the same pursuits as them.”
At a session on Wednesday, about 10 children ages 6 to 11 sat around a table and discovered to clean up saddles while other children had been using the horses. Many kids are animal enthusiasts and they say they get pleasure from spending time with their friends.
Kassandra Reichle, who started homeschooling her 5-year-old this calendar year, said it is crucial to observe the children’s lead in terms of what and how they want to understand. She feels the notion that homeschoolers are lacking social expertise is outdated. And she notes that there are a great deal of sources in the community today, which includes group routines, library and museum visits as nicely mom and dad support teams.
In addition, homeschooling parents host science and art functions and situations, trips and playdates. Team courses like the horseback riding application have been nonetheless another way for homeschoolers to find out and socialize in a team environment.
Reichle seems to be to get extra assistance and sources from both the school districts or municipalities. She hopes to meet up with other local homeschooling parents and share their expertise. She also would like to see some college gatherings that would include homeschoolers who stay inside the district, she states.
“If people have been offered the chance, we could all work alongside one another and help the young ones increase up with not only the tutorial side, but the social-psychological facet,” said Reichle. “Being able to support each individual other via a neighborhood is amazing.”
BRISTOL, Vt. (WCAX) – Bristol Elementary School pupils and workers say their university is in a condition of unrest and lots of worry for their basic safety. They say young children in crisis are not obtaining the appropriate care to continue to keep their habits less than control.
Instructors told me security problems arrived to a head final Thursday and Friday. I talked with 1 mom who suggests her initial-grader witnessed the chaos.
“He experienced gotten into the vehicle and variety of appeared distraught and I was like, you know, “How was your day, buddy?’ And he was like, ‘I just about witnessed a murder,’” said Megan Vaughan, a Bristol Elementary School dad or mum.
When Vaughan heard her 6-calendar year-old son say something so drastic, she understood the circumstance possibly was not that critical but a little something major experienced definitely happened.
Later on that night he advised his mom far more particulars. Vaughan states her son saw his good friend get pinned driving a desk, not able to breathe.
“Their classroom had been wrecked and that they had been evacuated to one more classroom and then into lockdown,” Vaughan explained.
Bristol Elementary Faculty lecturers say very last Thursday, two lecture rooms ended up forced to relocate to other workspaces even though a college student was in disaster. A initially-quality classroom sustained major injury.
The future day, the school underwent at minimum seven “secure the hallway” processes, which call for all college students and personnel to continue being in their school rooms whilst yet another college student is staying helped. The teachers union, Mount Abraham Education Affiliation, cites in a letter to the district that some employees users had been also injured.
“Kids ended up definitely terrified and staff members members ended up worried and concerned,” reported Andrea Murnane, a 2nd-grade trainer at Bristol Elementary.
Murnane is amongst a team of educators pleading with the Mount Abraham Union Faculty District to implement new policies that will hold young children protected when yet another university student loses management.
Tuesday evening, Murnane and other BES academics stood prior to the school board detailing the dangers and hurt to the constructing above the earlier few of months.
Murnane browse a assertion looking at in aspect, “Our university has turn out to be a spot of unrest when it should be a safe and sound haven.”
They want the district to undertake strategies to mitigate threat to pupils and workers, including but not restricted to eliminating college students from the constructing who endanger other people or them selves, giving a single-on-one behavioral aid to people kids in crisis, and choosing a psychological wellbeing experienced to educate workers for those people predicaments.
“I sense like we could be accomplishing extra to assist the them, and I truly feel like we could be carrying out far more to assist the children who are in the classroom,” Murnane explained.
The initial-quality teacher whose classroom was ruined explained the specifics of her ordeal Thursday, “My students had been crying and screaming and little ones had been hiding beneath tables in my classroom library.”
Vaughan says her son has grow to be desensitized to the violence due to the fact injuries to employees and college students at university occur so usually.
“Kind of can make you feel sick to your tummy a minimal bit simply because this is not regular,” she stated.
Superintendent Patrick Reen suggests he’s bringing with each other a workforce to tackle the difficulty.
He tells me that crew is assembly Thursday and will be collaborating with regional mental wellness providers to come up with options.
He acknowledges the latest structure obviously isn’t doing the job.
The coronavirus disease (COVID-19) remains a global threat, which has grappled several countries with a series of devastating waves.1,2 Undoubtedly, this pandemic disrupted almost all sectors of life, including education. Despite the availability of vaccines in many countries, the incidence of confirmed COVID-19 cases is trending upwards. These surging trends have resulted in rapid implementation of social distancing mandates and new norms limiting physical conducts in most of the educational institutes with one being school/college closures. Thus, several educational programs underwent sudden transition from face-to-face instructions to virtual or E-learning, which reportedly have posed several challenges in acquiring intended learning outcomes.3 Health sciences’ disciplines, including medical and dental education, faced the disproportionate disruption, particularly on learning of fine motor skills to provide clinical training.4
Dental education is aimed at training undergraduates for effective and safe management of dental patients. Further, the training differs from other graduate programs as the dentists need to acquire a broad level of professional elements, including theoretical knowledge, clinical and interpersonal skills, manual dexterity, and fine motor skills to deliver quality health care through a close proximity with patients.5,6 COVID-19 makes it challenging to strike an appropriate balance between the acquisition of desired educational outcomes and preventing virus transmission.7 Lockdowns and school/college shutdown imposed during the pandemic helped in curbing the spread, however these have impacted all aspects of training activities with limited or no access to preclinical and clinical learning opportunities for dental students worldwide.
During the pandemic, many dental schools halted in-person courses, clinical practice and migrated to didactic instructions online coupled with restricted hands-on preclinical and clinical learning in small groups.8,9 Dental institutions adapted to the “new normal” education system with the integration of video conferencing options to deliver education. The use of online platforms, such as Zoom, Google meet, video demonstrations, and live or stream videos, and pre-recorded lectures are some of the virtual teaching methods adapted by the dental colleges.8 Shifting to the online mode of learning during the pandemic was the essential in order to avoid the spread of infection as well as crowding.10
Virtual learning poses several advantages, such as transferring knowledge to a large number of recipients, accommodating different learning styles, and shifting passive teacher-centered learning to active learning.11 Although online platforms offer theoretical training, their use in practical training may be questionable. Although some disciplines of dentistry can function well with online teaching, others requiring patient interactions have limited opportunities to retain a seamless flow. For instance, in branches where patient care is the main objective, it is required for students to meet the prerequisite of pre-clinical hands-on training prior to the actual clinical work in order to ensure competency in patient management with dental diseases.12 Given the advancement and availability of technology, simulation of clinical environments through modalities, including haptics, Virtual reality/Augmented Reality-based simulation devices has been made possible without actually being in a clinical environment.13 However, these high-end technological devices are scarce or almost non-existent in resource-strained countries.14 According to the recent United Nations Educational, Scientific Cultural Organization (UNESCO) report, lower-middle-income countries (LMICs) spend only $48 for each learner as opposed to $8501 per individual among high-income countries.15 This highlights a huge disparity in per-capita education spending across these countries.15 COVID-19 has widened these disparities and has caused a dramatic change in the educational environment.8,9,15
Educational environment encompasses the infrastructure, behavior of the teachers, fellow students, and the teaching methodology used.16 Educational environment has a considerable impact on the effectiveness of curriculum and educational outcomes, with an increased emphasis on transferable skills in dental education.16,17 Successful dental teaching methodology intends to deliver transferable skills, including patient care and critical skills, teamwork, and health promotion.18 Pandemic-related lockdowns forced the switch to online teaching in order to continue providing education. Consequently, this mode may have affected the educational environment as well as its outcome, ie, transferable skills. Since the success of these changes largely depends on the perception of students, it is vital to identify students’ perceptions on this novel experience of virtual learning during the pandemic. This is highly important in dentistry, given the limited utilization of virtual platforms to provide practical clinical or preclinical training across LMICs.19
Previous studies have assessed the learning perception of educational environment and transferable skills among dental students using the DREEM (Dundee Ready Educational Environment Measure) questionnaire and students’ perception of transferable skills.18,20,21 However, the pandemic situation creates the need to evaluate the learning perceptions and transferable skills of dental students in the virtual classrooms. Furthermore, studies are available on the student’s perceptions of different e-learning modalities across various countries; however, little is known about the dental students’ perception in the developing countries of South Asia. It is important to compare students’ perception of learning across multiple LMICs of South Asia, as undergraduate dental students in this region have comparable resources and learning environments, which is significantly different from the developed nations. Therefore, the current study aimed to assess dental students’ perception of learning, education environment, skills to deliver patient care, and critical thinking skills gained through online learning platforms in dental education during COVID-19 pandemic across three LMICs, including, India, Nepal and Sri Lanka in the South Asian region.
Materials and Methods
Study Design and Setting
The cross-sectional study was conducted in three countries – India, Nepal and Sri Lanka, during the period 17th November 2020 to 17th March 2021. This period corresponds to the time period when online learning mode had been adopted for a minimum of 6 months in each country during the pandemic.
Ethical Considerations
An ethical approval regarding the conduction of the study was obtained from the respective ethical committees of each participating country (IEC/VSPMDCRC/25/2020, Institutional Ethical Committee Vidya Shikshan Prasarak Mandal Dental College and Research Center, India. ERC/FDS/UOP/E/2020/39 Ethical Review Committee, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka. 490/077/078-IRC, B.P Koirala Institute of Health Sciences, Nepal). Confidentiality and voluntary consent forms were attached to the questionnaire. A cover letter explaining the purpose of the study was also attached to the survey. It was ensured that no computer Internet Protocol (IP) addresses were collected, and investigators had no way of identifying the participating students.
Sample Recruitment
A sample of undergraduate dental students was recruited via a convenience sampling method across all three countries utilizing a uniform inclusion criterion: 1. All universities enrolled undergraduate dental students, received dental learning via online mode during the pandemic for at least 6 months; 2. Students, who were willing to participate and provide voluntary informed consent. Students, who were unable to comprehend English and those with no access to the internet were excluded from the study.
Questionnaire and Procedure
A web-based survey was administered using a 47-item psychometric valid instrument. The survey instrument or questionnaire consisted of three parts. Part one used three subscales of DREEM (Dundee Ready Educational Environment Measure) developed by Roff et al. 1. Student’s perception of learning (12 items), 2. Student’s academic self-perception (8 items), 3. Student’s perception of atmosphere (12 items).22 The DREEM questionnaire has been used previously for medical and dental professional programs, and is reported to be neither culture nor context-specific.23–25 Moreover, the DREEM has been widely used in evaluation for diagnostic purposes and comparing different groups.26 DREEM provides an opportunity to examine the individual items of the overall scale through the mean score obtained for each of the items. This further enables the identification of specific strengths and weaknesses within the educational environment. Each item was measured using a 5-point Likert scale ranging from 0 = strongly disagree, 1 = disagree, 2 = uncertain, 3 = agree to 4 = strongly agree. Scores in the first three domains had potential maximum values of 48, 32 and 48, respectively. Domain totals were calculated and transformed to percent score to allow inter-domain comparison. Part 2 of the questionnaire consisted of a domain selected from the perception of transferable skills questionnaire, which was developed by Sun et al.18 It is a valid and reliable tool to test students’ perception of transferable skill requirements. The domain-patient care and critical skills was selected for use in the present study consisting of 7 items that were scored on a 5-point Likert scale. Overall high scores indicated positive perception towards transferable of skills. The domain subscale reported the Cronbach Alpha value as 0.887.18 Part 3 of the questionnaire consisted of the demographics section which included 8 items.
The questionnaire for all three countries was in English, as this was the preferred language of teaching in all participating countries. The questionnaire was electronically distributed with the survey link being accessible online through WhatsApp and other social media platforms by the study investigators. The estimated time to complete the survey was approximately 10 minutes.
Statistical Analysis
Participants’ responses in Qualtrics were first preprocessed or cleaned and then exported to IBM SPSS version 26.0 (IBM Corp. Armonk, NY, USA) for statistical analyses. Incomplete responses and those with invalid data entries were excluded. Mean and standard deviation were used to represent continuous variables. Counts and proportions were used to express categorical variables. Inferential analyses were conducted through Pearson correlation, Chi-square tests, Independent samples-t-tests or Welch’s t-test (if equality of variance was not assumed) and One-way ANOVA. Tukey’s post hoc analysis was conducted if any of the mean differences across subgroups were found to be significant through One-way ANOVA. The Normality and Homoscedasticity assumptions were assessed through Shapiro–Wilk test, and F-tests. All the subscales of the survey instrument were subject to reliability analyses through Cronbach’s alpha. All analyses were conducted at α = 0.05. The sample size country was ascertained to detect a very small effect size (d = 0.2) at the 95{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} confidence interval to have sufficient power.27,28 The minimum sample required was 788. An additional 15{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} was added to account for incomplete entries (788+15{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} of 788 = 906). We used the Checklist for Statistical Assessment of Medical Papers (CHAMP) statement for reporting our results.29
Variables and Measures: For the demographic characteristics, we used variables such as age, gender, year of dental program, the current didactic method, webtools used for lectures and clinical demonstrations. We categorized our sample into preclinical and clinical subgroups depending upon the year of the dental program. For instance, First- and second-year students were preclinical, whereas third- and final-year students were included in the clinical category. The primary outcomes of interest (dependent variables) in this study were mean scores of SPL, SASP, SPA, and PISPC. These mean scores were compared among countries involved in this study.
Results
A total of 930 valid responses from all the participating countries were included in the final analysis. Of 930, 44.4{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} responses were from India alone, and remaining 55.6{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} responses were from Nepal and Sri Lanka (Table 1). Overall, the study population was predominantly females, which ranged from 61.3{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} to 80.6{e4f787673fbda589a16c4acddca5ba6fa1cbf0bc0eb53f36e5f8309f6ee846cf} across the participating countries. The highest proportion of the responses were from final-year students, forming a sizable part of the clinical group depending upon the curriculum. Every 5 in 10 Indian and Sri Lankan students reported “Online” didactic method as being predominantly used, while other didactic methods, including “completely in person” and “Hybrid” were the most commonly used in Nepal during the study period (Table 1). In India and Nepal, the lectures were delivered through live sessions, while Sri Lanka used pre-recorded lectures the majority of the time. Moodle was the most frequently used virtual platform in Sri Lanka, while India and Nepal used a combination of virtual platforms for lectures as well as clinical demonstrations (Table 1). The results of the one-way ANOVA indicate significant differences in the mean scores of students’ academic self-perception (SASP), students’ perception of learning (SPL), students’ perception of atmosphere (SPA), and perception of transferable skills of patient care (PTSPC) across countries (Table 2). Among all countries, students from Sri Lanka had the highest mean scores of academic self-perception indicative of a feeling more on the positive side (19.1±4.4), a more positive perception of learning (28.96±5.8), and a greater positive perception towards atmosphere (30.2±6.20; Table 2). The results of post-hoc Tukey’s test indicate that all scores corresponding to SASP (p value = 0.032), SPA (p value = 0.005), and PTSPC (p value = 0.02) were statistically different among India and Nepal. Similarly, Nepal and Sri Lanka were statistically different in the scores of SASP (p <0.001), SPA (p <0.001), and PTSPC (p value = 0.001).
Table 1 Demographic Characteristics of the Study Population (N = 930)
Table 2 Cross-Country Comparisons of Perceptions of Online Learning Among All Students
In India, 138 preclinical and 265 clinical students took the survey. An independent-samples t-test was run to determine if there were differences in the perceptions between preclinical and clinical dental students. There were no outliers in the data, as assessed by inspection of a boxplot. Mean perception scores for each level of curriculum (preclinical vs clinical) were normally distributed, as assessed by Shapiro–Wilk’s test (p > 0.05) and visual inspection of histograms. The clinical students in India had a significantly higher perception of atmosphere than the preclinical students (M = 29.5, SD = 6.90 vs M = 27.6, SD = 8.03; p value = 0.02; Table 3). Similarly, PTSPC mean score was higher among clinical students than preclinical students (M = 17.2, SD = 5.2 vs M = 15.8, SD = 5.1; p value = 0.01; Table 3).
Table 3 Cross-Country Comparisons of Perceptions of Online Learning Among Preclinical and Clinical Subgroups
In contrast, preclinical students in Nepal had a higher perception of atmosphere than the clinical students, and the results were marginally significant (M = 28.0, SD = 6.8 vs M = 26.3, SD = 5.8, p value = 0.05; Table 3). Additionally, preclinical students in Nepal reported having a significantly higher perception of learning than clinical students (M = 25.2, SD = 6.6 vs M = 21.6, SD = 7.3; p <0.0001; Table 3). In Sri Lanka, preclinical students had a significantly higher perception of learning than clinical students (M = 30.0, SD = 4.7 vs M = 28.0, SD = 6.5; p value = 0.01; Table 3). The mean PTSPC score was higher among clinical students than preclinical students in Sri Lanka (M = 19.1, SD = 3.5 vs M = 15.3, SD = 4.6; p<0.0001; Table 3). Reliability diagnostics of all constructs were performed, and the scale had a high level of internal consistency, as determined by a Cronbach’s alpha that ranged from 0.827 to 0.937 overall (Table 4). The lowest yet reasonable Cronbach’s alpha values were found for SPA (0.761) and SASP (0.788) in Nepal and Sri Lanka, respectively (Table 4). Results of Pearson correlation indicated a moderately positive correlation between SPL and PTSPC (r = 0.43; Table 5). A similar level of moderate correlation was found between SPA and PTSPC (r = 0.45; Table 5). A large or strong correlation was found between SPL and SASP (r = 0.67), SPL and SPA (r = 0.68), SASP and SPA (r = 0.62), SASP and PTSPC (r = 0.63) (Table 5).
Table 4 Reliability Diagnostics
Table 5 Correlation Between Constructs of Learning Perceptions and Transferable Skills
On calculating item-wise mean scores of DREEM constructs, a total of 11 problem areas in Nepal, followed by six in India, and only two problematic areas in Sri Lanka were identified (Table 6). Among all countries, the majority of improvement areas were found in students’ perception of learning (SPL) domain. One problem area corresponding to item “the online teaching overemphasizes factual learning” was identified among all participating countries.
Table 6 Areas of Strength and Improvement According to the Scores of Items of DREEM Domains Across Countries
Discussion
The results of the current study indicated that the dental students of India, Sri Lanka and Nepal had an overall positive perception of the educational environment and transferable skills in online education. However, the item-wise analysis indicated several problem areas based on the responses of the students from each country. Countries in the South Asian region share comparable resources and learning environments, which are remarkably different from the resources available in high-income or developed nations.15 In countries, such as India, Pakistan, Nepal and Sri Lanka, online learning was not a regular part of the teaching curriculum in dental colleges, and it was quickly adopted given the pandemic’s rapid progression and its subsequent social distancing mandates.30–33 Similar observations were made in other developing countries like Ukraine, where distance learning was successfully implemented; however, the authors raised concerns regarding development of practical clinical skills; while in Iran, medical departments uploaded study material on the university website.34,35
The finding of positive perception was consistent with the previous study, that indicated positive perception, acceptability and usability of online mode of learning by the dental students.11 Factors such as ease of access with new online tools, flexibility in time and place of access and relaxed environment in internet-based clinical case-based discussions could have contributed to the overall positive perceptions.36,37
On comparing the overall mean scores, a statistically significant difference was observed across all domains – perceptions of academic self-perception, perception of learning, perception of atmosphere, perception of patient care and critical skills among three countries. Possibly, factors such as year of the training, political, cultural and economic conditions can influence students’ perception and attitude of the students towards education.20,38 All three countries used different modes of online learning tools. While there are limited data available on the selection of an appropriate online teaching platform in terms of students’ behavior, engagement and learning, the use of different modes of online learning could have partly contributed to the cross-country differences found by the current study.39
The students’ perception of learning, atmosphere and academic self-perception together make essential measures of the educational environment, mean scores of which were found to be highest in students of Sri Lanka. The educational environment can directly or indirectly affect learning, and includes several components, such as rooms for lectures, tutorials and clinical activities, facilitators and barriers of learning, learning opportunities, atmosphere created by fellow students; and faculty including teaching, clinical and administrative staff.16,40 This can possibly impact the behavior of students, their approach towards studies, and the educational outcomes, given the well-established association between students’ perception towards the educational environment and their academic performance.17,20,41,42
Another critical component, investigated throughout the study, was transferable skills pertaining to patient care. Transferable skills can be understood as skills that provide support across disciplines, and have the potential to be transferred to various settings within the educational or workplace context.43 More recently, Olesen et al highlighted the importance of transferable skills for future healthcare workers to adapt effectively to the evolving condition during practice.44 Dental education aims to develop the competency in dental students along six main domains: professionalism, communication and leadership, critical thinking, health promotion, scientific and clinical knowledge, and patient care.45 Recently, there has been an increased emphasis on assessing the students’ understanding and perception of transferable skills as these are essentials for their overall development and employability.46,47 Moreover, previous studies have highlighted the importance of transferable skills in patient care in later years of practice as the practitioner gains more experience, evaluating effectiveness of dental teaching programs and the future practitioners’ holistic development.18,47,48
Our study found a significant association between transferable skills in patient care and other components of the educational environment (SPL, SASP and SPL). The assessment of perception of the environment will provide an insight into the students’ self-perceptions and understanding regarding their perception of transferable skills in critical thinking and patient care.48 Consistent with previous reports, the learning environment is an important indicator for ascertaining the effectiveness of curriculum implementation as well as a precursor for the provision of effective learning.41,49,50
The results of this study also indicate the impact of dental curriculum type (preclinical vs clinical) on students’ perception of learning. The overall comparison of scores indicates that the preclinical students perceived higher learning and academic self-perceptions and lower perceptions with regard to atmosphere and transferable skills. Similar results were obtained by Ansari and Kossioni, who reported second-year students with higher perception scores with significant differences in the domain of SPL.20,51 These differences may be attributed to the fact that certain aspects of dental education can be taught more easily using online mode compared to others, such as lectures, although the preclinical/simulation/laboratory training and clinical training are more challenging to teach using remote instruction methods.8 However, the absence of simulation devices in low resourced countries like India, Nepal and Sri Lanka; and challenges regarding online simulation practical pre-clinical training may have contributed to lower SPA and PTSPC scores in the pre-clinical group. Additionally, it is easier to impart the theoretical concepts in the earlier years (preclinical) which may be supportive towards the current use of online mode. On the other hand, the use of clinical case discussion and problem-based learning in clinical-based topics using online learning may be of use in various colleges across the three countries, resulting in higher PTSPC scores across the clinical groups.
Further analysis resulted in identification and understanding of the perceptions and problems identified by the students pertinent to individual countries within the framework of the study. Overall, students from India indicated a positive perception in the SPL, SASP and SPA. The combination of the previous academic years’ clinical exposure and use of YouTube videos for clinical demonstrations could be responsible for higher scores in all the domains by the clinical group.12 With access to the high-speed internet and lack of difficulties encountered by Indian students, effective use of the various online teaching modes in dental colleges could be responsible for giving a positive perception.30 In the context of SPL, when the individual items in subscales were analyzed, the students identified many problem areas. This implies the need to modify the teaching content as per online mode of teaching. Teaching methods such as the use of problem-based learning and virtual patient-based learning, use of flipped classrooms/blended learning methods, use of learning management systems, such as Canvas, Examsoft, and Brightspace to conduct examinations remotely and analyze feedbacks from faculty and students for improvement of effectiveness of online learning methods can be taken up by the educational authorities in India for future improvements.14,52
The data from Sri Lanka indicated positive perception towards e-learning. The reliance on Moodle platform which enables access to material at a varied pace for all types of learners, can be assumed to be a large contributor. While the mean score of SPL, SASP and SPA were less in clinical subgroup, these observations could be due to lack of clinical training due to the ongoing pandemic. In order to improve the issues regarding online teaching that overemphasize factual learning, it is suggested that investment in user-friendly and versatile online resources may further improve e-learning activities and outcomes.32 The results from Sri Lanka initiate thought regarding incorporation of learning resources like case studies, quizzes, discussions through virtual platforms, which may enhance students’ learning environment and perception of transferable skills.
The results from Nepal showed the lowest mean scores of SASP, SPL and SPA. When the preclinical and clinical students’ perceptions were compared in Nepal, both the preclinical and clinical students perceived SASP, SPA positively; however, the clinical students perceived negatively. Regarding the PTSPC, the clinical students showed higher scores. Increased use of other platforms for clinical demonstrations like YouTube could be responsible for the results obtained. Even though the students showed an overall positive perception, they identified 11 out of 12 items as problem areas. Previous research has pointed at how the students as well as faculty perceived online mode of learning as ineffective or moderate in Nepal.33,53 Various challenges in using online learning in Nepal have been pointed out, such as IT infrastructure, faculty’s competencies and their training/support, students’ access to computer/internet, conducive home environment for e-learning, etc.33 Future improvement in the faculty skill, incentives and reward for the development and delivery of online content and improved institutional strategies are suggested for better perceptions of online learning in Nepal.54
There are only limited studies from India, Sri Lanka & Nepal in this regard and this research work provides certain lines of continuous quality improvement and innovation that may add towards the quality in the changing world dynamics for the subcontinent. In order to continue effective dental education in pandemic-like situations, future studies on the effectiveness of e-learning solutions in dental education can be performed. Through a combined effort by the countries in the South Asian region with similar resources, efforts should be made in the development of affordable e-learning solutions.
The study has several strengths: firstly, to our knowledge, this is the only study that analyzed the perceptions of dental students across three countries of South Asian region regarding online education during the pandemic, and secondly the perceptions of educational environment using online mode of learning during the pandemic have not been analyzed before.
However, this study has certain limitations. First, due to the cross-sectional nature of the study, causality could not be inferred. Second, self-reporting bias may have been introduced as it can be driven by the feelings of the respondents at the time of taking the survey. Third, the findings will have limited generalizability as not all universities across the three countries participated in the study. Fourth, other variables related to economic conditions were not collected, which may have contributed to the lower scores of perceptions. Lastly, language bias may have been introduced in the study as the medium of the survey used was English only. In addition, selection bias might have been introduced in the study as only students with internet access were included.
Conclusion
The dental undergraduate students in India, Nepal and Sri Lanka showed an overall positive perception regarding the educational environment and transferable skills for the online mode of learning during the COVID-19 pandemic, whilst the students in each country identified problem areas that are in the need of attention. Moreover, significant differences in all the domains analyzed were found between all three countries. The highest mean scores in all the domains were reported by dental students in Sri Lanka. The results of the current study can be used to direct developments in delivering online dental education in the future in resource strained countries.
Abbreviations
UNESCO, United Nations Educational, Scientific Cultural Organization; LMIC, Lower-Middle-Income Countries; DREEM, Dundee Ready Educational Environment Measure; IBM SPSS, International Business Machines Corporation Statistical Package for Social Sciences; ANOVA, Analysis of Variance; SASP, Students’ academic self-perception; SPL, Students’ perception of learning; PTSPC, Perception of transferable skills of patient care; SPA, Students’ perception of atmosphere.
Data Sharing Statement
Data will be available from the corresponding authors upon request.
Consent for Publication
All the authors of the manuscript confirm that the details of the manuscript can be published.
Author Contributions
All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval for the version to be published; and agreed to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.
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Pewapsconias hails from Saskatchewan’s Tiny Pine To start with Nation. With the inventive intellect energy of her sister and discussions with her family, Pewapsconias founded Neeched Up Game titles.
“It was fashioned from this heartwarming second in the extremely commencing,” Pewapsconias claimed. “It’s an interacting working experience.”
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There is a easy intention in brain — use an interactive board sport to educate the game’s gamers on Indigenous tradition.
Pewapsconias reported it’s a fun and meaningful way to teach a player of any age who wants to have interaction and discover much more.
“I’m coming from this at an educated, decolonizing point of view, working with humour, wellbeing and Indigenous society to assistance affect individuals,” Pewapsconias reported.
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What started out in youth corporations shortly distribute to sites of finding out, this kind of as elementary educational facilities, higher faculties and universities.
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The College of Saskatchewan‘s director of social accountability in the College or university of Medication, Manuela Valle-Castro, mentioned in this working day and age, there needs to continue to be the option for any society or men and women to be involved in culture “in purchase to make significant contributions to society.”
“In buy to be represented in lifestyle, they need to have to entry to take part in culture as a entire,” Valle-Castro mentioned.
A single professional mentioned it is crucial for artists to specific them selves in this method and for more to appear to the forefront as nicely in the long run in get to be certain an avenue for long term artists of Indigenous backgrounds.
“To make stories and to provide people that are building and envisioning these creative kinds due to the fact we need to have artwork and tradition to endure, to empower us to transfer ahead,” Valle-Castro mentioned.
Indigenous video clip match character primarily based on Saskatchewan woman’s track record
Indigenous video video game character based mostly on Saskatchewan woman’s history – Aug 8, 2021
The learning-by means of-undertaking task is a huge function-playing board game featuring playing cards and significant dice. With each individual flip, gamers are mentioned to be immersed in Indigenous culture, which include Indigenous language, geography and labels, to identify a several.
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Pewapsconias mentioned no person loses in the activity and the final intention is looking at youth take again their identities.
“To me, that is what is most significant, devoid of indicating words, that is the biggest compliment, seeing youth come to feel empowered when they go away the house at the end of the day,” Pewapsconias instructed Global Information.
Pewapsconias and Valle-Castro sense far more Indigenous, understanding-centered written content is necessary through the prairies and in Saskatchewan.
“It’s so vital to the betterment of creating inclusion for Indigenous people,” Valle-Castro reported.
Pewapsconias reported she is hoping to additional increase the access of Neeched Up Games to a bigger audience by creating more in an on-line format or digital fact in the long term.
/cloudfront-us-east-1.images.arcpublishing.com/gray/R4CBRB2CJVCNDF6XKSYYEORSNM.jpg "Violence, fear at Vt. elementary school as kids in crisis disrupt classes")
