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Five Research-Based Ways to Teach Vocabulary

Did you know that typically, only 5% to 10% of instructional time is devoted to vocabulary instruction, yet students, especially struggling students and English learners (ELs), need between 12 and 14 exposures to words and their meanings to fully learn them (Durkin, 1978/79; Roser & Juel, 1982; Scott, Jamieson, Noel, & Asslin, 2003)? Teaching the meanings of important words before learning new content activates students’ background knowledge and prepares them for learning and comprehending. In other words, teaching vocabulary provides the “Velcro” for new information to “stick to.”

What Research Says About Effective Vocabulary Instruction

Vocabulary instruction must be explicit . Explicit vocabulary instruction includes an easy-to-understand definition presented directly to students along with multiple examples and nonexamples of the target word, brief discussion opportunities, and checks for understanding.

Vocabulary instruction must include multiple practice opportunities for using words within and across subjects . That is, instruction must be extended over time with opportunities for students to hear, speak, read, and write words in various contexts. This builds students’ breadth and depth of vocabulary knowledge.

Vocabulary should be taught schoolwide and across all subject areas . Each subject has a unique set of vocabulary terms, and students need to know their meanings and how to use them in various contexts.

Word Selection

Instructional time is precious, and teachers are not able to address every unknown word students might encounter, so careful word selection is key . When deciding which words to target for explicit instruction, consider words that are

  • essential to understanding the main idea of the text or unit,
  • used repeatedly or frequently encountered across domains, and
  • not part of students’ prior knowledge.

ELs may require even more careful word selection and extensive vocabulary instruction because they may be learning conversational language and academic language at the same time. Colorín Colorado provides additional information about selecting vocabulary words to teach ELs .

Some of Our Favorite Vocabulary Instructional Activities for ALL Content Areas

The five activities described below are effective ways to teach vocabulary for all students, but especially for struggling students, students with learning disabilities, and ELs.

1. Essential Words Routine

Teachers use a simple graphic organizer to preteach the meanings of important words in about 5 minutes per word. During this routine, teachers introduce target words with definitions, visual cues, and examples. Students engage in immediate practice using the words through collaborative student turn-and-talk activities.

research on vocabulary teaching strategies

  • Vocabulary Maps Toolkit from Middle School Matters
  • Reading Instruction for Middle School Students: Developing Lessons for Improving Comprehension (see page 11)

2. Frayer Model

One way to have students extend their knowledge of important words is through a Frayer model. This graphic organizer builds vocabulary and conceptual knowledge across content areas. The strategy requires students (not the teacher) to define a vocabulary word and then list its characteristics, examples, and nonexamples. Frayer models can be completed in collaborative groups using textbooks and other subject-matter materials while the teacher circulates around the classroom and assists students.

Online module, examples, and templates from the IRIS Center

3. Semantic Mapping

Semantic maps visually display and connect a word or phrase and a set of related words or concepts. Implementing semantic map activities in your classroom will help students, especially struggling students and students with learning disabilities, recall the meanings of words and understand how multiple words or concepts “fit together.” Teachers will find that using a semantic map, combined with explicit instruction and practice opportunities, is an effective way of expanding students’ vocabulary and supporting their content knowledge.

  • Introduction to semantic maps and sample lesson plans from the Developers of PowerUp What Works
  • Semantic mapping teaching strategy guide from PowerUp What Works

4. Vocabulary Review Activities

Multiple opportunities to practice using new words is an important part of vocabulary instruction. In previous TCLD research studies, brief review activities were built into novel unit lesson plans to help students practice (and remember) the meanings of important words. Each of these activities takes 5 to 10 minutes and is easy to prepare.

research on vocabulary teaching strategies

  • Partner Review Routine:  Partners work together to quickly review words learned the previous day.
  • Sentence Review Routine:  Partners create sentences using words assigned by the teacher.
  • Examples and Nonexamples:  The teacher tells students scenarios or shows pictures and students respond chorally to each scenario, indicating whether it is an example or nonexample.
  • What Word Fits?  The teacher asks a question and student partners hold up an index card with the word that fits or answers the question.

Each activity is described in more detail beginning on page 33 of the TCLD booklet Reading Instruction for Middle School Students: Developing Lessons for Improving Comprehension

5. Morphemic Analysis Routine

Explicit instruction of words is important, but it is impossible to teach all the unfamiliar words students will encounter. One way to help students develop strategies for approaching unfamiliar vocabulary is to teach morphemes (prefixes, roots, and suffixes). Students can be taught the following morphemic analysis routine to help them engage in independent word study.

research on vocabulary teaching strategies

Learn more about the morphemic analysis routine by reviewing this online learning module from the Texas Adolescent Literacy Academies.

Have questions? Feel free to drop us a line !

Current Perspectives on Vocabulary Teaching and Learning

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  • Samuel Barclay 2 &
  • Norbert Schmitt 3  

Part of the book series: Springer International Handbooks of Education ((SIHE))

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This chapter reviews key vocabulary research and draws a number of conclusions regarding teaching and learning. Areas addressed include the amount of vocabulary required to use English; what it means to know and learn a word; the incremental nature of vocabulary acquisition; the role of memory in vocabulary learning, incidental, and intentional vocabulary learning; and the implementation of a systematic approach to vocabulary teaching and learning. This chapter also introduces principles by which activities can be developed for vocabulary teaching and instruments that will help teachers choose effective tasks. The insights and techniques discussed in this chapter can help teachers develop principled vocabulary programs for their students.

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Barclay, S., Schmitt, N. (2019). Current Perspectives on Vocabulary Teaching and Learning. In: Gao, X. (eds) Second Handbook of English Language Teaching. Springer International Handbooks of Education. Springer, Cham. https://doi.org/10.1007/978-3-319-58542-0_42-1

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Effective Vocabulary Instruction Fosters Knowing Words, Using Words, and Understanding How Words Work

Margaret g. mckeown.

a Department of Instruction and Learning, University of Pittsburgh, PA, Emerita

This clinical focus article will highlight the importance of vocabulary instruction, in particular, thinking about instruction in terms of focusing students' attention on words and their uses. Vocabulary knowledge that supports literacy and academic learning is extensive and multidimensional. Many learners accumulate high-quality vocabulary knowledge independently, through wide reading and rich language environments that provide abundant practice with words and language forms. However, instruction in vocabulary provides a more efficient way of getting that job done, especially for learners who are less likely to be experiencing rich language interactions, for example, because they struggle with reading and do little of it on their own.

Three aspects of vocabulary instruction, choosing words to teach, the inclusion of morphological information, and the importance of engaging students in interactions around words, will be explored. Considerations in choosing words include their role in the language and their utility to students. Morphology will be discussed in terms of using Latin roots in instruction as a resource for unlocking new word meanings and a framework for understanding language.

Effective instruction means bringing students' attention to words in ways that promote not just knowing word meanings but also understanding how words work and how to utilize word knowledge effectively.

How many words do you know? You deal with an abundance of words every day, comfortably and fluently. You are breezing along in this text right now with hardly a thought to what you know about each word. However, you have no idea, no way of knowing, just how many words you know. So many words are available to us to process with ease, yet an accounting of those words is beyond our reach. This illustrates why it is hard to get a handle on the role and importance of vocabulary learning. Just as the extent and depth of one's knowledge remains elusive, it is hard to understand the extent and depth of knowledge that needs to be acquired by students for them to experience literacy and academic success. Learning—and teaching—vocabulary is a bit of a stealthy process.

The most obvious aspect of a word's meaning is its definition. However, knowing a definition is by no means the essence of word knowledge. A rich variety of information is needed about each word in order to support high-quality literacy and academic learning. Useful theoretical perspectives on word knowledge have been offered by many scholars (e.g., McKeown, Deane, Scott, Krovetz, & Lawless, 2017 ; Nagy & Scott, 2000 ; Perfetti, 2007 ). The emphases in their perspectives differ, but three key characteristics are clear in all three:

  • There are many aspects to know about a word, including features of its meaning, situations in which it is used, associations with other words, and how it behaves syntactically in context.
  • Words are polysemous; their meanings are not static but shift according to context. These shifts may be large or subtle; for example, accommodate can mean physically providing room for someone and providing for someone's need or request, or it can take a more metaphorical sense of being able to understand a new idea that may challenge your perspective.
  • Word knowledge is incremental, gradually developing over multiple encounters.

Given the complex nature of word knowledge, learners need to develop knowledge that allows them to access meaning rapidly when reading and to use that meaning to make sense of the various contexts in which a word might be encountered. Rapid access to word meanings that are relevant to a given context is necessary to keep comprehension from slowing down and eventually breaking down. Making sense of the range of contexts in which any word might appear requires flexible knowledge that can adapt to different uses of words.

Many learners accumulate high-quality vocabulary knowledge independently, mainly through extensive reading and rich language environments that provide abundant practice with words and language forms. However, instruction in vocabulary provides a more efficient way of getting that job done. A more efficient route to vocabulary knowledge is especially critical for learners who are less likely to be experiencing rich language interactions, for example, because they struggle with reading and do little of it on their own. Lack of adequate vocabulary knowledge can too easily cause these students to be left behind in developing literacy, and many of them will never catch up. The consequence is that a great deal of individual and societal potential goes unrealized.

However, all students can benefit from high-quality vocabulary instruction. Even students who have a large vocabulary repertoire can enrich their knowledge in ways that make it more accessible and productive. For example, it is well accepted that words can be known to different levels of knowledge. As Carey (1978) pointed out in her seminal research on fast and extended mapping of word knowledge, every learner is working on as many as 1,600 word meanings that are in various stages of being known. It seems reasonable that instructional interactions around language can have benefits for a range of learners, even though the words being learned and the pace at which learning accumulates vary for different learners. Instruction may be initiating knowledge for some learners, whereas it may be reinforcing, clarifying, and extending knowledge for others.

As educators take on the responsibility of teaching vocabulary, issues of how to proceed center on which words to teach and the nature of the instruction. This clinical focus article first focuses on selecting which words to teach, based on their utility and role in the language. The focus then turns to an aspect of language that is both a feature of words and a potential aspect of instruction, morphology, which is the structure of words and word parts. The third focus of the clinical focus article is the nature of vocabulary instruction itself, in particular, features that make instruction most effective.

Which Words to Teach?

A starting point in considering which words merit instructional attention is the nature of the English language. Language is a dynamic human creation and, thus, inherently a bit of a mess.

Ancestry of English

English, even more than most other languages, is a mishmash, because of historical influences on how the language developed into the English we know today. English began as a Germanic language, Anglo-Saxon or Old English. However, this early language mingled with other languages, with the biggest influence being Latin. Latin influenced English over centuries, either directly or through other Romance languages, especially French. The greatest influence began with the Norman conquest of 1066, which brought French, as spoken by the upper classes, and Latin as the language of books and official documents. In fact, English mingled with Latinate vocabulary to such an extent that modern English seems as much a Romance language as a Germanic language, as far as its word-stock ( Baugh & Cable, 1978 ).

The Germanic versus Latinate divide is significant in how our language is used. The Germanic segment of our word-stock mainly consists of simple, concrete words that typify oral, conversational language. The Latinate portion includes more abstract words that characterize more academic language as found in texts. Of course, the common, high-frequency words are found in text as well. In fact, they make up the majority of words found there. However, the portion of words that particularly characterize text is key to comprehending text. Those words carry the semantic burden in written language.

Consider, for example, the text segment below from the New York Times ( Casey & Escobar, 2018 ). In this 49-word segment, the majority—about 38—of the words are high frequency. Yet, without the lower frequency, italicized, and bolded words, it would be difficult to make sense of this passage. The italicized words are considered academic words; the bolded words are more common, but are used here in a metaphorical sense:

“The peace accords …were meant to bring an end to five decades of fighting that left at least 220,000 dead. Behind the agreement, though, loomed a fear: That many of the thousands of fighters granted amnesty might sour on civilian life and pick up arms again.” (NY Times, Sept 19, 2018; front page)

The divide between conversational and written aspects of English has been labeled the lexical bar ( Corson, 1985 , 1995 ). Corson emphasizes the need for learners to cross this lexical bar or move from using everyday language to mastering text language. This move can be difficult but is crucial to academic success. Crossing the lexical bar requires understanding and using sophisticated, literate vocabulary.

The divide between everyday words and the language of text was the starting point for the notion of word tiers ( Beck & McKeown, 1985 ; Beck, McKeown, & Kucan, 2002 , 2013 ). The concept originated when colleagues challenged our recommendations for direct vocabulary instruction, saying that there were too many words in the language to teach them all. We countered, saying that there was no need to teach all the words. We conceptualized a three-tier heuristic by considering that different words have different utility and roles in the language. Tier 1 words characterize everyday oral language, and children learn these readily when hearing them in context. Tier 3 includes words that tend to be limited to specific domains (e.g., chromosome) or extremely rare ( abecedarian ) and are best learned within their domains.

Tier 2 comprises words that are characteristic of written language (e.g., coherent, diminish, or eloquent) and not so common in conversation ( Hayes & Ahrens, 1988 ). These are words of high utility for literate language users. Tier 2 words overlap to a great extent with general academic words, that is, words that are common across various domains of academic texts. Good databases of academic words include Coxhead's (2000) Academic Word List (AWL) and Gardner and Davies' (2013 ) more recent Academic Vocabulary List. Each of these lists is based on a large corpus of words from sources such as academic journals and university textbooks across broad academic areas. A difference between academic words and Tier 2 words is that Tier 2 includes words from fiction, whereas academic words are drawn from nonfiction, disciplinary texts. Thus, Tier 2 includes words that typically apply to characters and emotions, such as sinister, mutter, and obsessed . We think these kinds of words are good candidates for instruction, for several reasons. They can help students read and enjoy fiction, they provide students with interesting words to use in describing people and human interactions in writing, and they are rather delicious and fun! Students enjoy, for example, imagining what sinister characters might do or demonstrating muttering versus murmuring.

Children typically have a rather small repertoire of Tier 2 words when they enter school but increase Tier 2 knowledge as they become readers. Tier 2 words are more difficult to learn than Tier 1 words, partly because they are less frequent in the language as a whole—thus the frequent repetition that aided learning Tier 1 words is gone—but also because written context in which Tier 2 words typically appear provides less information about a word's meaning than the immediate oral contexts in which Tier 1 words are found. Think of it this way: When children hear words spoken every day, they have the physical surroundings, gesture, intonation, and familiarity of their everyday life to support figuring out word meaning. However, when they read, or are read to, they have only other words to glean information from.

An important caveat about word tiers is that it is an imprecise concept. It was meant as a heuristic to help bound the selection of words to teach and also to draw attention to properties of words and their roles in the language that make some words more useful to know. Classrooms are typically inundated with words from the various curricular materials that teachers and students deal with. The tiers concept can support teachers in selecting from among that sea of words those words that are most beneficial to attend to and keep around. Tier 2 words are beneficial to learn because they are found in a variety of texts and can thus provide access to a range of contexts.

Yet, the fact that Tier 2 words can apply to varied contexts also means that these words have multiple related senses or nuances—they are polysemous. Negotiating these shades of meaning can be tricky for learners. A typical sticking point in learning vocabulary is that, when we learn a word, we initially learn a particular sense and then we tend to use that sense to understand subsequent contexts we meet. Thus, if we learn the word foundation as an organization that provides funding and then meet a context about people building a “foundation of friendship,” we might think it means an organization that provides funding for friendships.

Rampant polysemy is, then, another reason for giving students supported practice with using these kinds of words. By providing varied contexts and supportive interactions around them, students become able, for example, to understand that a student with academic potential is one who has the ability to be a good student and a merchant's potential customer is someone who might buy from them. Probing two such contexts also helps students to see that at the core of potential is a meaning of “possibility of becoming something in the future.” Word knowledge needs to become decontextualized—generalized beyond specific contexts—to provide the kind of flexibility learners will need as they meet words in new contexts.

As the above discussion of polysemy suggests, it is important to give attention to different senses or nuances of word meaning in instruction. However, it is not necessary to try to include every sense that a word might have—that could get way too confusing! Part of the reason for focusing on different senses is to help students build a general understanding that words can shift their meaning in different contexts and to understand the limits of that. The way my colleagues and I have handled polysemous senses is to provide a definition that describes the core concept of a word, which is broad enough to cover various senses. We employed these kinds of definitions in the middle school vocabulary program we developed called RAVE (Robust Academic Vocabulary Encounters; McKeown, Crosson, Beck, Sandora, & Artz, 2012 ). For example, the definition of approach applied to getting physically closer to something and a way to deal with or solve an issue: “If you approach something, you get closer to it in order to reach it or to deal with it.” Then, we presented contexts that used the word in both ways and asked students to explain what the context meant. So, for example, for a context such as “Our group had to come up with a new approach for our science project,” the teacher would guide students to understand that the group was trying to figure out a new way to create a science project.

It is important not to confuse polysemy, multiple senses or nuances of related meaning, with words that have multiple unrelated meanings. The latter are actually homographs, words that are spelled the same but with no similarity in meaning. Examples would be fast as in speed and fast as in to forego food. There is no reason to make a habit of introducing homographs of instructed words. That is likely to breed confusion. The only circumstances for introducing a homograph would be to avoid confusion with an already known word. So, for example, if fast , meaning to forego food, is being taught, mention that students probably already know fast as meaning a high rate of speed but that this is another word that sounds and looks the same and has a different meaning.

Consideration of Tier 2 words can provide a focus and a mindset, but it still may not make it easy to find and select precisely which words to teach. It can seem that there are, at once, too many words to choose from and not enough “really good words” to share with students. Which are the right ones? First of all, there is no definitive list of words that students must know. The best guide is to choose from texts students are reading in the classroom, which already come with attached contexts to launch from. Thinking about how to choose among words that appear in texts and curricular materials can be spurred by inspecting lists such as the AWL and the Academic Vocabulary List. Other resources for lists of words include Stahl and Nagy (2006) and Beck, McKeown, and Kucan (2008) , which present sets of lists for particular texts and websites that offer word lists for particular content areas, texts, and grade levels (see, e.g., https://www.vocabulary.com and https://www.spellingcity.com ). However, all of these lists should be used along with one's own prudent judgment, which should include considerations of the word's general utility and, specifically, if it seems useful to one's particular students—can you imagine your students finding a way to use the words?

A special case of selecting words can occur when students are reading at levels below their thinking or language comprehension levels. This can occur with both younger and struggling readers. Materials for these students may not offer abundant useful words to teach as far as vocabulary development. A strategy we have used is to select “words about” the text. For example, a simple story may tell the tale of a boy and his dog. You could introduce the word companion . Or a story might portray a child's excitement about an upcoming birthday. You could introduce anticipate or eager. The best overall strategy for selecting words is to tune your attention to be on the lookout for good words in texts or in experiences that students will interact with. Go for words that are important to a text and frequent enough in the language that learning them is worthwhile.

As far as appropriateness for students of different ages and reading levels, when focusing on increasing students' knowledge of word meanings, Tier 2 words are appropriate for every level. For example, here are some words we have taught—and students have learned and used—in kindergarten: extraordinary, commotion, inseparable, cautious, reluctant, delicate, stingy, and remarkable. Note that these words, although considered Tier 2, are not highly polysemous and not as abstract as many on the AWL. The point is to prepare students for language they will be meeting as they go up the grade levels and encounter increasingly academic language. Even if students are not mastering all words that are introduced, the initial experiences are valuable for this preparation.

Why Include Morphology?

One aspect of vocabulary instruction universally understood in the field is that not only would it be an impossible task to teach every word but it would also be impossible to teach even a majority of agreed-upon, important-to-know words. One way to leverage instruction is to attend to general patterns of language, with morphology being the most prominent among those.

What Are Morphemes?

Morphology is the study of morphemes, the smallest units of language that have identifiable meaning or function. Types of morphemes include prefixes, suffixes, and roots. So, for example, unthinkable has three morphemes: un, think, and able . Think is the freestanding root; that is, it can stand on its own as a word. However, our language also contains bound roots, which are word parts that have meaning across words but cannot stand by themselves, such as nov in novel and renovate or voc in vocabulary and advocate . These bound roots are mostly from our Latin heritage, although there are some Greek roots as well.

There are several ways to categorize morphemes:

  • Bound or free: Free are basically single-morpheme words, whereas bound morphemes are either affixes or Latin roots.
  • Inflectional or derivational: Inflectional morphemes are suffixes added to a word to change number or tense, for example, the – s in dogs or – ing in many verbs. Derivational morphemes are prefixes or suffixes that change the meaning of a word, such as prefixes un – and re– or suffixes –tion and – able .
  • Content or function: Content morphemes are morphemes that carry semantic meaning. These include words that are nouns, adjectives, adverbs, and verbs, as well as derivational morphemes and bound (Latin or Greek) roots. Function (also called grammatical ) morphemes are words or suffixes that serve a functional role, such as prepositions, pronouns, or inflectional morphemes.

What Does Research Say About Including Morphology in Vocabulary Study?

A strong and growing body of research shows that knowledge of morphology contributes to reading comprehension ( Anglin, 1993 ; Carlisle, 1995 , 2000 ; Nagy, Berninger, Abbott, Vaughan, & Vermeulen, 2003 ). However, evidence that instruction in morphology leads to enhanced comprehension is less clear. Results of morphological instruction show that students often learned the meanings for the word parts they were taught but rarely generalized that to the learning of new words ( Bowers, Kirby, & Deacon, 2010 ; Curtis, 2006 ). However, recent meta-analyses by Goodwin and Ahn (2013) and Bowers et al. (2010) provided evidence of enhanced spelling and vocabulary learning across 21 morphological interventions and some, albeit small, transfer to new words and to reading comprehension. Virtually, all research on morphology has focused on derivational morphology (prefixes and suffixes). In some instances, Latin roots were occasionally included in instruction, but their effects were not analyzed separately.

Understanding of Latin roots can provide students with some generative knowledge of language that they can use to unlock meanings of unfamiliar words and a way to give students some understanding of how English got to be the way it is. Providing information about English and its Latin layer can “take the lid off language” to help students see its inner workings. Teaching students about the patterns that words follow makes students aware of the connections within language, such as that duplicate and duplicity have double at the core of their meaning. Understanding patterns of language would seem to help students deal with language and its oddities and feel more in control of their language.

My colleagues and I first added a component of Latin root instruction when we developed our middle school RAVE program ( McKeown et al., 2012 ). We called that component Becoming Aware of Language and introduced it by presenting two key concepts about language: that languages are constantly changing and that all languages adopt words from other languages—with English adding a lot of vocabulary from Latin. The RAVE program then introduced several Latin roots in each weekly cycle of instruction. We selected roots that came from the target words and then introduced several more words with the same root. For example, manipulate was one of the target words, and in the Becoming Aware of Language lesson, we introduced the root man, meaning hand, and root-related words manicure, manager, and emancipate (a good resource for identifying roots of words is an online etymological dictionary found at etymonline.com ).

A potential downside of teaching Latin roots is that roots lack consistency phonologically and orthographically. For example, the root sed, meaning to sit, can also be spelled sid —as in preside . Additionally, the meaning of a Latin root within a word is not always transparent. Consider a set of words that contain the root voc, meaning speak or call. That semantic component is easy to understand in the words vocabulary, vocal, vociferous, and even advocate, meaning to speak for someone. However, that same root also occurs in vocation, which has a more metaphorical relation to the root: A vocation is a calling to some endeavor or profession.

Because roots may demonstrate lack of consistent form or lack of transparent meaning, one principle built into our instruction was flexibility: teaching students to be alert to variations and ready to adapt their thinking about the meaning of a new word they meet. We provided practice in this concept by having activities that asked students to problem-solve by working out meanings of words given contexts that contained an unfamiliar root-related word. For example, we presented a picture of a group of people painting a room, with the caption “These friends are renovating an old house.” Students had already learned that nov meant new and then used the visual and semantic context to figure out that the friends were working to make the house new again.

Despite potential downsides of teaching Latin roots, our view is that knowing about roots, and having some knowledge of specific roots and the words in which they appear, is a resource that students can draw on when encountering a new word in context. This knowledge provides a little extra boost to using context alone to puzzle out new word meaning. Even though learners learn most of the words they know from context, it is notoriously unreliable, as writers write to express ideas, not to teach words. Context may hold strong clues to a word's meaning, or little or no clue, and may even misdirect readers as to word meaning (see, e.g., Beck, McKeown, & McCaslin, 1983 ).

In our RAVE work, we did find evidence that students could use their knowledge of roots to unlock the meaning of unfamiliar words ( Crosson & McKeown, 2016 ). For this study, RAVE and control students were given a task that asked them to provide the meaning of root-related words in context. For example, RAVE taught the word diminish and the root min, and in the study task, we presented the sentence “Most of their conversations were about the minutiae of daily life” and asked “What is this saying about their conversations?” We found that RAVE students were significantly more able to provide an accurate interpretation of the word and context, saying, for example, that the conversations were about small details of life.

In a subsequent project, a vocabulary program designed specifically for English learners focused even more strongly on Latin roots. That program is discussed in another article in this forum ( Crosson, McKeown, Robbins, & Brown, 2019 ).

Full instruction in lexical morphology is likely not appropriate for students younger than upper elementary. However, teachers or clinicians can certainly take advantage of opportunities when working with young students. For example, if the words vocabulary and vocal have been encountered, you might mention that they both have voc in them, which means speak, and ask how that relates to each word. No need to go into language history or Latin, but just plant the seed about language having meaningful parts.

Keys to Effective Instruction

Effective instruction means bringing students' attention to words in ways that promote not just knowing word meanings but also understanding how words work and how to utilize word knowledge effectively in higher level tasks, such as reading comprehension. Research on vocabulary development, vocabulary instruction, and its relationship to comprehension has a long and rich history (see Baumann, 2009 ). Over several decades of investigation, a strong consensus has formed about features of effective vocabulary instruction, which can be summarized as follows: present both definitional and contextual information, provide encounters with words in multiple contexts, and engage students' active processing of word meanings. This research has included reviews of multiple studies and individual intervention studies that compare more traditional instruction to instruction that included broad information about words and activities to engage students with using words. Table 1 presents some of the key research milestones that were instrumental in leading to that consensus. More recent intervention research has confirmed that consensus in studies that focus on students as young as kindergarten ( Coyne, McCoach, Loftus, Zipoli, & Kapp, 2009 ; Coyne et al., 2010 ; McKeown & Beck, 2014 ; Silverman, 2007 ) and even preschool ( Wasik & Bond, 2001 ) and on English learners ( Carlo et al., 2004 ; Kieffer & Lesaux, 2012 ). Additionally, a recent meta-analysis confirmed that explicit instruction and depth of processing yield the strongest effects for children at risk ( Marulis & Neuman, 2013 ).

Research milestones in establishing consensus on vocabulary instruction.

To reiterate, these principles of effective instruction have been found to apply for teaching word meanings for all students—students of all levels, pre-K through high school; learners learning English as an additional language; and learners with learning disabilities. Note, however, that teaching word meanings differs from teaching students to read. Reading requires a different kind of instruction and practice. Although it is a good practice to at least familiarize students with the orthographic representations of words being taught for meaning, the emphasis and goals are different.

The need for instruction that focuses on definitional and contextual information, encounters in multiple contexts, and active processing stems from the nature of word meaning itself. Because word meaning is, as discussed earlier, multifaceted, polysemous, and flexible, it should be clear, first, that a definition of a word will not suffice for effective learning. A definition can only capture limited information, and although definitions can be a good starting point, or good shorthand for remembering a word's meaning, knowing definitions will not support comprehension ( McKeown, Beck, Omanson, & Pople, 1985 ; Stahl & Fairbanks, 1986 ).

The multifaceted, polysemous nature of word knowledge also means that vocabulary learning is incremental. It is virtually impossible to learn everything you need to know about a word from just one encounter. Experiencing words in multiple contexts leads learners to build rich networks of connections to a word and across similar words. A word's meaning becomes generalized across encounters, losing its connection to specific contexts, which allows it to be applied flexibly to new contexts. Flexible knowledge enables learners to bring the most relevant aspects of a word's meaning to bear in making sense of subsequent contexts in which the word is met ( Reichle & Perfetti, 2003 ).

However, simply encountering words in multiple contexts does not maximize learning. A learner needs to engage in active processing of the information in those encounters in order to reap top benefits. Active processing means interacting with words—manipulating ideas around words in order to extend and deepen knowledge of the word, its uses, and its connections to other words and situations. This is requisite for building the kind of rich and flexible knowledge that will support students in comprehending and using language.

The focus of this section is what effective interactions that engage students' active processing look like. The core of such interactions is really pretty simple—prompt students to do something with the words that encompasses thinking about features of a word's meaning and how the word can be used. The activities presented are generally examples of activities that teachers have used with whole classrooms, but they could easily be used or slightly adapted to be used in a clinical setting, such as by a speech-language pathologist and an individual student. The activities are appropriate for all levels as well. The same activity formats can be used with kindergartners or high schoolers; the words themselves and the responses of the students drive the maturity level of the discussions. The examples used here are from first grade, second grade, and middle school.

The following examples illustrate interactions that are intended to prompt student thinking about different aspects and features of word meaning. Experiencing this variety helps students build a flexible, reflective approach to words and their uses. This first activity helps students think about how different words can relate to the same contexts and to choose the word they would apply. The teacher would then follow up by asking the student to explain how their choice fits:

  • Try out a flying machine
  • Taste a new food made of seaweed
  • Taste a new kind of chocolate
  • Enter a singing contest

Interactions that ask students to make choices can prompt them to reflect on a word's features, for example, the extent of change that refine entails.

  • Making some small changes to your science project or starting all over with a new one?
  • Getting your hair trimmed or having your head shaved?

It is important to include interactions that prompt students to think about different senses of a word, such as the different senses of expose in the following:

  • How could middle school students be exposed to what it will be like in high school?
  • How could you expose someone who was mistreating his dog?

Interactions can and should be quick and fun! We have seen teachers turn up the fun quotient in various ways. One example is the way they ask students to indicate their response. A teacher we worked with told her first-grade students, “If you think I'm talking about something that is mighty, show me your muscles,” and then provided examples such as “a strong woman lifting up a tiger” and “a big river that floods nearby homes.”

Interactions should include providing feedback to students, for example, asking “why” when a student responds to the eager/reluctant prompts. Feedback helps to build and reinforce connections to a word in the student's mental lexicon.

Asking students to provide their own examples of a word is an interaction strategy that is easily implemented and potentially effective. For example, simply ask “What is something in your life that you would like to refine?” or “What is something you are always eager to do?” Asking students to create their own examples, however, should not be one of the first activities students are asked to do with a newly introduced word. Students often have difficulty coming up with their own ideas initially and often repeat the context in which a word has been introduced. So calling on students' creative use of words is best employed after students have been exposed to a number of uses and had time to reflect on how it might apply to them.

Feedback is especially important for interactions that prompt student-created examples, to monitor understanding and keep responses on the right track or redirect if necessary. A good way to build an effective habit of feedback is to think about the rule of thumb of improv comedy—“Yes, and…,” which involves acknowledging what someone has said and then expanding on it. In an improv troupe, this keeps the comedy rolling; in vocabulary instruction, it keeps the connections building. Note the “yes, and”-ing in the following exchange:

Teacher: What is something you'd want if you were famished? Student: Pizza. Teacher: Mm, pizza! And what would you do with that pizza if you were famished? Student: Gobble it all right up! Teacher: Oh, boy, yeah, because if you're famished, do you want just one piece of pizza?

Note in this next example that the teacher's “and” allows her to prompt students to generalize about entailments of the target word delicate .

Teacher: What are some things that are delicate ? … Student 1: A glass vase. Student 2: A brand new baby. Teacher: What is it about delicate things, like vases and babies? How do we have to act around them? Student 3: Be really, really careful….

Although the above examples of “yes, and” are from a classroom discussion, that technique is strongly applicable to clinical interactions between one child and a clinician. A clinician is in a good position to tailor feedback to a student's individual needs and interests.

Because vocabulary learning requires multiple exposures and because time with students is a precious resource, we need to seek ways to leverage attention to words, or figure out how to get more bang for the buck! Having a clinician coordinate with a student's classroom teacher could offer an ideal opportunity to leverage attention to vocabulary. A clinician can ask the classroom teacher for words that the class is focusing on or words that a particular student needs help with. The clinician is in a good position, then, to apply playful techniques, such as the activities exemplified above; to provide practice in vocabulary; and to build enjoyment with language. The clinician is also in a good position to provide extension and enrichment, for example, by introducing other words that associate with the classroom vocabulary. Because the activities suggested set a conversational, spontaneous tone, they might allow the clinician to identify gaps in a student's vocabulary repertoire and both directly help with those and inform the teacher about words that seem unfamiliar to a student or difficult for a student to use.

Another way for clinicians to enhance vocabulary attention is through their own word use. This can start with awareness of their own language use, deliberately using sophisticated words—both those that are being taught and others that are appropriate to situations—in interactions with students. Challenge students to “catch” you using target words and then turn it around—challenge students to use target words during lessons and provide some sort of points or simple rewards when they do.

Another important leverage point in vocabulary instruction is prompting students to use and be aware of words outside formal instruction. Such prompting can start with informal coordination among school professionals—classroom teacher, clinician, and beyond. This might begin with posting a list of target words on the classroom door and privately encouraging other adults to use the words when they visit or when students work with them. A next level of increased attention could include a vocabulary bulletin board, posting interesting uses of target words, both those found in written materials and those that students have generated.

Going beyond instructional sites for vocabulary should also include going beyond school, motivating students to take their vocabulary awareness home with them. Clinicians can easily take a lead role in this and then prompt the classroom teacher to join in. Challenge students to find target words in books they are reading, in menus, music, and video games, and to use the words with their families. My colleagues and I have promoted these kinds of activities in two studies and found that students respond with enthusiasm! However, best of all, we found that it affects the outcomes. In a fourth-grade study, when students were offered the opportunity to find words outside class through an activity we called Word Wizard , we found increased comprehension effects over instruction that did not include the Wizard component ( McKeown et al., 1985 ).

In a study with sixth graders, we invited them to engage through In the Media , an activity that challenged them to find their words in any media outside school. We received great response, including students finding words in sports broadcasts— dynamic players—and in Sunday school verses! In that study, we found that students who engaged with In the Media had greater learning gains on a vocabulary posttest ( McKeown, Crosson, Artz, Sandora, & Beck, 2013 ). Although our direct experiences have involved fourth grade and middle school students, we have worked with teachers who have had success with such activities with students from kindergarten through high school.

If students do not respond at first to the idea of finding words, that activity can be seeded with some specific directions to spur students on. For example, ask them to notice in something they read, hear, or see, such as

  • someone who does something voluntary
  • someone who needs to adapt to a new situation
  • someone who had to consult with another person.

Or you might ask them to choose one of their vocabulary words to describe

  • a character in a book they are reading
  • someone on the news or in the newspaper
  • someone in a commercial
  • an actor in a video or movie.

As a final point, it is necessary to include a caveat to clinicians: You may be disappointed to find that teachers you work with devote little, if any, time to vocabulary. Even if they do, the words they work with may not be the best choices for generative vocabulary building, but words with specific and narrow use in curricular materials. If that situation is in play, you are on your own—so I implore you to take up the mantle of vocabulary progenitor! This can flow from a cultivated interest and attention to words and word use. Choose words that appear in student materials or that emerge from current school or community events, for example. Use newspapers, websites, word lists such as the AWL ( Coxhead, 2000 ), or words you bump into in your own reading to create a set of words to use with students. Included in the Appendix are the words we taught in RAVE, all of which are taken from the AWL.

Wrapping Up

Always keep in mind that language is a strange, fascinating, vibrant human creation. Exploring its puzzlements and figuring out its patterns should be endlessly intriguing. Sparking that kind of attitude in students takes them a long way toward being successful, confident language users. Clinicians and teachers can propel students along that way by choosing useful, interesting words, helping students get an initial understanding of them through multiple exposures and lively interactions, and clinicians and teachers, as well as other school personnel in contact with students, can encourage students to notice and revel in words in their environment. The essence of all these activities that keep attention focused on vocabulary is to generate excitement around words and students' uses of them.


The author gratefully acknowledges the Institute for Education Sciences of the U.S. Department of Education for its support to some of the research described in this clinical focus article: Robust Instruction of Academic Vocabulary for Middle School Students, Award R305A100440 granted to Margaret G. McKeown and Isabel L. Beck from the Institute of Education Sciences, U.S. Department of Education. The opinions expressed do not necessarily reflect those of the institute, and no official endorsement should be inferred.

Words Taught in Robust Academic Vocabulary Encounters Program

Funding statement.

The author gratefully acknowledges the Institute for Education Sciences of the U.S. Department of Education for its support to some of the research described in this clinical focus article: Robust Instruction of Academic Vocabulary for Middle School Students, Award R305A100440 granted to Margaret G. McKeown and Isabel L. Beck from the Institute of Education Sciences, U.S. Department of Education.

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The Importance of Vocabulary Development

According to Steven Stahl (2005), “Vocabulary knowledge is knowledge; the knowledge of a word not only implies a definition, but also implies how that word fits into the world.” We continue to develop vocabulary throughout our lives. Words are powerful. Words open up possibilities, and of course, that’s what we want for all of our students.

Key Concepts

Differences in early vocabulary development.

We know that young children acquire vocabulary indirectly, first by listening when others speak or read to them, and then by using words to talk to others. As children begin to read and write, they acquire more words through understanding what they are reading and then incorporate those words into their speaking and writing.

Vocabulary knowledge varies greatly among learners. The word knowledge gap between groups of children begins before they enter school. Why do some students have a richer, fuller vocabulary than some of their classmates?

  • Language rich home with lots of verbal stimulation
  • Wide background experiences
  • Read to at home and at school
  • Read a lot independently
  • Early development of word consciousness

Why do some students have a limited, inadequate vocabulary compared to most of their classmates?

  • Speaking/vocabulary not encouraged at home
  • Limited experiences outside of home
  • Limited exposure to books
  • Reluctant reader
  • Second language—English language learners

Children who have been encouraged by their parents to ask questions and to learn about things and ideas come to school with oral vocabularies many times larger than children from disadvantaged homes. Without intervention this gap grows ever larger as students proceed through school (Hart and Risley, 1995).

How Vocabulary Affects Reading Development

From the research, we know that vocabulary supports reading development and increases comprehension. Students with low vocabulary scores tend to have low comprehension and students with satisfactory or high vocabulary scores tend to have satisfactory or high comprehension scores.

The report of the National Reading Panel states that the complex process of comprehension is critical to the development of children’s reading skills and cannot be understood without a clear understanding of the role that vocabulary development and instruction play in understanding what is read (NRP, 2000).

Chall’s classic 1990 study showed that students with low vocabulary development were able to maintain their overall reading test scores at expected levels through grade four, but their mean scores for word recognition and word meaning began to slip as words became more abstract, technical, and literary. Declines in word recognition and word meaning continued, and by grade seven, word meaning scores had fallen to almost three years below grade level, and mean reading comprehension was almost a year below. Jeanne Chall coined the term “the fourth-grade slump” to describe this pattern in developing readers (Chall, Jacobs, and Baldwin, 1990). 

Incidental and Intentional Vocabulary Learning

How do we close the gap for students who have limited or inadequate vocabularies? The National Reading Panel (2000) concluded that there is no single research-based method for developing vocabulary and closing the gap. From its analysis, the panel recommended using a variety of indirect (incidental) and direct (intentional) methods of vocabulary instruction.

Incidental Vocabulary Learning Most students acquire vocabulary incidentally through indirect exposure to words at home and at school—by listening and talking, by listening to books read aloud to them, and by reading widely on their own.

The amount of reading is important to long-term vocabulary development (Cunningham and Stanovich, 1998). Extensive reading provides students with repeated or multiple exposures to words and is also one of the means by which students see vocabulary in rich contexts (Kamil and Hiebert, 2005). 

Intentional Vocabulary Learning Students need to be explicitly taught methods for intentional vocabulary learning. According to Michael Graves (2000), effective intentional vocabulary instruction includes:

  • Teaching specific words (rich, robust instruction) to support understanding of texts containing those words.
  • Teaching word-learning strategies that students can use independently. 
  • Promoting the development of word consciousness and using word play activities to motivate and engage students in learning new words.

Research-Supported Vocabulary-Learning Strategies

Students need a wide range of independent word-learning strategies. Vocabulary instruction should aim to engage students in actively thinking about word meanings, the relationships among words, and how we can use words in different situations. This type of rich, deep instruction is most likely to influence comprehension (Graves, 2006; McKeown and Beck, 2004).

Student-Friendly Definitions

The meaning of a new word should be explained to students rather than just providing a dictionary definition for the word—which may be difficult for students to understand. According to Isabel Beck, two basic principles should be followed in developing student-friendly explanations or definitions (Beck et al., 2013):

  • Characterize the word and how it is typically used.
  • Explain the meaning using everyday language—language that is accessible and meaningful to the student.

Sometimes a word’s natural context (in text or literature) is not informative or helpful for deriving word meanings (Beck et al., 2013). It is useful to intentionally create and develop instructional contexts that provide strong clues to a word’s meaning. These are usually created by teachers, but they can sometimes be found in commercial reading programs.

Defining Words Within Context

Research shows that when words and easy-to-understand explanations are introduced in context, knowledge of those words increases (Biemiller and Boote, 2006) and word meanings are better learned (Stahl and Fairbanks, 1986). When an unfamiliar word is likely to affect comprehension, the most effective time to introduce the word’s meaning may be at the moment the word is met in the text.

Using Context Clues

Research by Nagy and Scott (2000) showed that students use contextual analysis to infer the meaning of a word by looking closely at surrounding text. Since students encounter such an enormous number of words as they read, some researchers believe that even a small improvement in the ability to use context clues has the potential to produce substantial, long-term vocabulary growth  (Nagy, Herman, and Anderson, 1985; Nagy, Anderson, and Herman, 1987; Swanborn and de Glopper, 1999).

Sketching the Words

For many students, it is easier to remember a word’s meaning by making a quick sketch that connects the word to something personally meaningful to the student. The student applies each target word to a new, familiar context. The student does not have to spend a lot of time making a great drawing. The important thing is that the sketch makes sense and helps the student connect with the meaning of the word.

Applying the Target Words

Applying the target words provides another context for learning word meanings. When students are challenged to apply the target words to their own experiences, they have another opportunity to understand the meaning of each word at a personal level. This allows for deep processing of the meaning of each word. 

Analyzing Word Parts

The ability to analyze word parts also helps when students are faced with unknown vocabulary. If students know the meanings of root words and affixes, they are more likely to understand a word containing these word parts. Explicit instruction in word parts includes teaching meanings of word parts and disassembling and reassembling words to derive meaning (Baumann et al., 2002; Baumann, Edwards, Boland, Olejnik, and Kame'enui, 2003; Graves, 2004).

Semantic Mapping

Semantic maps help students develop connections among words and increase learning of vocabulary words (Baumann et al., 2003; Heimlich and Pittleman, 1986). For example, by writing an example, a non-example, a synonym, and an antonym, students must deeply process the word persist .

Word Consciousness

Word consciousness is an interest in and awareness of words (Anderson and Nagy, 1992; Graves and Watts-Taffe, 2002). Students who are word conscious are aware of the words around them—those they read and hear and those they write and speak (Graves and Watts-Taffe, 2002). Word-conscious students use words skillfully. They are aware of the subtleties of word meaning. They are curious about language, and they enjoy playing with words and investigating the origins and histories of words.

Teachers need to take word-consciousness into account throughout their instructional day—not just during vocabulary lessons (Scott and Nagy, 2004). It is important to build a classroom “rich in words” (Beck et al., 2002). Students should have access to resources such as dictionaries, thesauruses, word walls, crossword puzzles, Scrabble® and other word games, literature, poetry books, joke books, and word-play activities.

Teachers can promote the development of word consciousness in many ways:

  • Language categories:  Students learn to make finer distinctions in their word choices if they understand the relationships among words, such as synonyms, antonyms, and homographs. 
  • Figurative language:  The ability to deal with figures of speech is also a part of word-consciousness (Scott and Nagy 2004). The most common figures of speech are similes, metaphors, and idioms.

Once language categories and figurative language have been taught, students should be encouraged to watch for examples of these in all content areas.

Teaching Words and Vocabulary-Learning Strategies With Read Naturally Programs

Take aim at vocabulary: build vocabulary in the middle grades.

These intentional vocabulary learning strategies can be efficiently and effectively implemented using Read Naturally’s program Take Aim! at Vocabulary. Take Aim is appropriate for students who can read at least at a fourth grade level. Take Aim is available in two formats:

  • The semi-independent format provides differentiated instruction for students working mostly independently.
  • The small-group format is designed for small-group instruction—up to six students.

Each Take Aim level teaches 288 carefully selected target words in the context of engaging, non-fiction stories. The target words are systematically taught using the research-based strategies described above. The intensive and focused lesson design helps students learn the target words and internalize the skills and strategies necessary for independently learning unknown words.

Learn more about how Take Aim teaches vocabulary and word-learning strategies:

  • Take Aim at Vocabulary product page
  • Take Aim samples
  • Research basis for Take Aim at Vocabulary

Splat-O-Nym: Vocabulary Word Game for iPad

Splat-O-Nym logo

Learn more about the Splat-O-Nym app:

  • Splat-O-Nym product page
  • Research basis for Splat-O-Nym

Other Programs That Support Vocabulary Development

These other Read Naturally programs do not focus on vocabulary but include activities that support vocabulary development:


Anderson, R. C., & Nagy, W. E. (1992). “The vocabulary conundrum,” American Educator , Vol. 16, pp. 14-18, 44-47.

Baumann, J. F., Edwards, E. C., Boland, E., Olejnik, S., & Kame'enui, E. (2003). “Vocabulary tricks: effects of instruction in morphology and context on fifth grade students’ ability to derive and infer word meanings,” American Educational Research Journal , Vol. 40, No. 2, pp. 447–494.

Baumann, J. F., Edwards, E. C., Font, G., Tereshinski, C. A., Kame'enui, E. J., & Olejnik, S. (2002). “Teaching morphemic and contextual analysis to fifth-grade students.” Reading Research Quarterly , Vol. 37, pp. 150–176.

Baumann, J. F., Kame'enui, E. J., & Ash, G. E. (2003). “Research on vocabulary instruction: Voltaire redux,” in J. Flood, D. Lapp, J. R. Squire, and J. M. Jensen (eds.), Handbook of research on teaching the English language arts, 2nd ed. , Mahwah, NJ: Erlbaum, pp. 752–785.

Beck, I. L., McKeown, M. G., & Kucan, L. (2002). Bringing words to life. Robust vocabulary instruction , New York: Guilford Press.

Beck, I. L., McKeown, M. G., & Kucan, L. (2013). Bringing words to life. Robust vocabulary instruction, 2nd ed. , New York: Guilford Press.

Biemiller, A. & Boote, C. (2006). “An effective method for building meaning vocabulary in the primary grades,” Journal of Educational Psychology , Vol. 98, No. 1, pp. 44–62.

Chall, J. S., Jacobs, V. A., & Baldwin, L. E. (1990). The reading crisis: Why poor children fall behind , Cambridge, MA: Harvard University Press.

Cunningham, A. E. & Stanovich, K. E. (1998). “What reading does for the mind,” American Educator , Vol. 22, pp. 8–15.

Graves, M. F. (2000). “A vocabulary program to complement and bolster a middle-grade comprehension program,” in B. M. Taylor, M. F. Graves, and P. Van Den Broek (eds .), Reading for meaning: Fostering comprehension in the middle grades , New York: Teachers College Press.

Graves, M. F. (2004). “Teaching prefixes: As good as it gets?,” in J. Baumann & E. Kame'enui (eds.), Vocabulary instruction, research to practice , New York: Guilford Press, pp. 81–99.

Graves, M. F. (2006). The vocabulary book , New York: Teachers College Press, International Reading Association, National Council of Teachers of English.

Graves, M. F. & Watts-Taffe, S. M. (2002). “The place of word consciousness in a research-based vocabulary program,” in A. E. Farstrup and S. J. Samuels (eds.), What research has to say about reading instruction , Newark, DE: International Reading Association.

Hart, B. & Risley, T. R. (1995). Meaningful differences in the everyday experience of young American children , Baltimore, MD: Paul H. Brookes.

Heimlich, J. E. & Pittleman, S. D. (1986). Semantic mapping: Classroom applications , Newark, DE: International Reading Association.

Kamil, M. L. & Hiebert, E. H. (2005). “Teaching and learning vocabulary: Perspectives and persistent issues,” in E. H. Hiebert and M. L. Kamil (eds.), Teaching and learning vocabulary: Bringing research to practice , Mahwah, NJ: Erlbaum.

McKeown, M. G. & Beck, I. L. (2004). “Direct and rich vocabulary instruction,” in J. Baumann & E. Kame'enui (eds.), Vocabulary instruction, research to practice , New York: Guilford Press, pp. 13–27.

Nagy, W. E., Anderson, R. C., & Herman, P. A. (1987). “Learning word meanings from context during normal reading,” American Educational Research Journal , Vol. 24, pp. 237-270.

Nagy, W. E., Herman, P. A. & Anderson, R. C. (1985). “Learning words from context,” Reading Research Quarterly , Vol. 20, No. 2, pp. 233–253.

Nagy, W. E. & Scott, J. A. (2000). “Vocabulary processes,” in M. L. Kamil, P. Mosenthal, P. D. Pearson, and R. Barr (eds.), Handbook of reading research , Vol. 3, Mahwah, NJ: Erlbaum.

National Reading Panel. (2000). Teaching children to read: An evidence-based assessment of the scientific research literature on reading and its implications for reading instruction (NIH Publication No. 00-4769), Washington, DC: U.S. Government Printing Office, pp. 13–14.

Scott, J. & Nagy, W. (2004). “Developing word consciousness,” in J. Baumann & E. Kame'enui (eds.), Vocabulary instruction, research to practice , New York: Guilford Press, pp. 201–215.

Stahl, S. A. (2005). “Four problems with teaching word meanings (and what to do to make vocabulary an integral part of instruction),” in E. H. Hiebert and M. L. Kamil (eds.), Teaching and learning vocabulary: Bringing research to practice , Mahwah, NJ: Erlbaum.

Stahl, S. A. & Fairbanks, M. M. (1986). “The effects of vocabulary instruction: A model-based meta analysis,” Review of Educational Research , Vol. 56, pp. 72–110.

Swanborn, M. S. & de Glopper, K. (1999). “Incidental word learning while reading: A meta-analysis,” Review of Educational Research , Vol. 69, pp. 261-285.

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Building Connection and Common Ground: How to Help Multilingual Learners Succeed

Five research-supported strategies and recommendations from touro's graduate school of education.

New York City has always been a melting pot, and with over 800 languages spoken across the five boroughs, it’s considered the world’s most linguistically diverse city. For teachers, that presents a unique challenge, but it also opens a world of opportunity.

Dr. Seong-shin Kim is department chair for the Teaching Students of Other Languages (TESOL) program at Touro University Graduate School of Education (GSE), and one of her favorite aspects of working with multilingual learners (MLs) is the diversity of the students. “I love the field of multilingual learning,” she enthuses. “You don’t have to travel to see the world—you have the world right there in your classroom!”

She also appreciates the power she has to make a difference in her students’ lives. “Teachers can have a lot of impact on students – almost as much as YouTube!” she laughs. “Students take teachers’ words to heart, and one kind word from a teacher can change a student’s life. Plus, we get to help students uncover their goals and then give them the tools to achieve those goals.”

Taking an open-minded and empathetic approach is just one of the ways she connects with her students and sets them up for success. Keep reading to find even more of the research-proven strategies that Dr. Kim recommends for supporting multilingual learners.

1. Support multilingual learners by setting clear, actionable objectives

According to Dr. Kim, one of the most crucial aspects of teaching multilingual learners begins long before a teacher ever sets foot in the classroom. “To even start lesson planning, teachers need to think about learning objectives—and for multilingual learners, there are two goals.”

The first goal is the same one that applies to all students: Identify the content objective, or what the student should learn from the lesson. Then, for ML learners, teachers also need to consider the language objective—or how they’ll teach the English language in a way that will achieve the content goal. Both goals need to be measurable and to clearly show students exactly what they’re expected to accomplish with the lesson, such as “Generate five sentences about birds.”

“Teachers sometimes complain about this and don’t think it’s necessary, but for MLs, it can be a lifesaver,” Dr. Kim stresses. She explains that when a person hears a foreign language, their brain grasps for any words they recognize and then builds context around those words, which often gives them the totally wrong idea. “The objective tells a student what the lesson will be about and gives them permission to disregard the small things that are unrelated.”

2. Give multilingual learners the same baseline by building background

Another component that helps to put multilingual learners in a position to succeed is known as “building background.” To explain it, Dr. Kim offers the analogy of taking your car to a mechanic. If you don’t know much about cars and the mechanic starts throwing around a bunch of technical terms, there’s a good chance you’ll get overwhelmed—and you may even shut down and just ask for your bill.

However, if the mechanic takes a minute to explain what’s happening in plain language, you can build a baseline understanding so you can get a rough idea of what’s happening with your car. That’s exactly what building background does of ML students. “We have to help students to become ready to accept new knowledge,” Dr. Kim says, “and for that, they need baseline knowledge.”

Building background is particularly necessary for multilingual students. While American children generally have similar cultural experiences and contextual knowledge, many students from other countries have had vastly different experiences and opportunities to learn. Even if they’re the same age or grade level, they most likely will not all have the same baseline understanding.

When it comes to building background, Dr. Kim recommends an activity called the “vocabulary quilt.” Children are broken into small groups, and each group receives a paper “quilt” that has one vocabulary word written on each square. Each child receives a different colored pen, and they’re asked to write everything they know about each vocabulary word on its designated square.

The beauty of this subtle assessment is that it allows a teacher to figure out what each student knows without causing any embarrassment. Simply by matching the color of the writing to each student’s pen, a teacher can see who knows what and who needs a little more explanation. As a bonus, students also learn from each other as they watch and read what their peers are writing on the quilt, further building their baseline.

3. Focus on providing comprehensible input to enable multilingual understanding

While teachers are generally confident in their ability to effectively explain information, there is a caveat: That capability only applies to students who have the same background and beliefs or the same way of thinking. Since ML students bring a unique diversity—in backgrounds, beliefs, and cognitive style—teachers may have more success by focusing on comprehensible input.

Comprehensible input is simply finding ways to make information understandable to a diverse audience. That could mean incorporating images or YouTube videos into lessons or giving students ways to show what they know without language, like creating a portfolio or a drawing. Teachers can also provide opportunities for peer interaction, since students often feel more comfortable talking to their friends—who can explain concepts or instructions at their own level.

Additionally, Dr. Kim points out how teachers may need to adjust their teaching styles or make allowances as students adjust to American learning, sharing her own story coming to the US for graduate school as an example. In her home country of Korea, learning primarily happened by rote memorization, but in the US, her assignments required much more creativity. “My teacher let me look at other students’ work to understand what needed to be done, and I’d turn in the assignment a week later,” she recalls.

Finally, Dr. Kim offers tried-and-true suggestions like avoiding idioms and watching the rate of speech. “When you encounter a native speaker, they speak so fast!” she exclaims. Scaffolding, which Dr. Kim describes as “I do, we do, you do,” can also be an effective technique for comprehensible input and building independence.

4. Embrace empathy and give multilingual learners the benefit of the doubt

While many students feel nervous or self-conscious in the classroom, Dr. Kim notes that multilingual learners are particularly vulnerable. “They have an accent, they have incorrect pronunciation, they confuse words, they’re afraid to say something wrong, and they feel very embarrassed,” she expounds.

Because of this, she suggests teachers take care to approach these students with empathy and compassion, use subtle assessments like the vocabulary quilt, and be mindful not to embarrass them in front of their peers. “Loud correction creates a barrier between a teacher and a student, and after it goes up, no more learning will happen,” she stresses.  “Being subtle is key for working with multilingual learners.”

Another recommendation from Dr. Kim: “When you teach MLs, put down your suspicion that they’re trying to cheat or get away with something.” She points out that trying to write an answer in their own words can be an incredible challenge, so instead they might memorize a whole paragraph and recite it verbatim to show they’ve learned it. “Instead of thinking that they’re trying to copy or cheat, recognize the effort they put in to memorize and give them credit for trying to learn,” she suggests.

Lastly, she suggests focusing on the influence teachers have on their students—and what those students might go on to accomplish. She recalls a time when she was working in Kansas, and her school received a grant to recruit and educate new ML teachers. When they asked candidates why they were interested in the job, every single one mentioned a former teacher who believed in them, and they were excited to have that same positive influence on other students.

“Think about all the good things kids will do in the world!” Dr Kim says. “We want MLs to know and love our language and culture and to contribute in positive ways. Encouragement and support from a teacher can put them on the path to achieve their goals. It can change their life!”

5. Build more skills with the Touro Graduate School of Education MS in TESOL

If you’re looking for more practical ways to support multilingual learners, the Master in Teaching English to Speakers of Other Languages (TESOL) program from Touro University Graduate School of Education was designed to help current NYS-certified PreK-12 teachers better instruct and communicate with a diverse range of students.

“Our pillar is Sheltered Instruction Observation Protocol,” say Dr. Kim. “It’s made up of eight components that include all the proven approaches and methods, which researchers officially tied together into a template.” By using this compilation of effective approaches, the TESOL master’s degree curriculum gives teachers the assessment tools and strategies to create inclusive and effective learning environments where all students can thrive.

This academically rigorous and practice-intensive program is made up of 33 credits, with courses that guide students through the distinct aspects involved in teaching English language learners. It covers topics that range from sociolinguistics and second language acquisition to curriculum development in a multicultural context to the ways diversity impacts individual learning and community development.

Students also complete 5-15 hours of fieldwork embedded in each course and at least 10 days or 50 hours of  supervised student teaching  experience. Via this practicum, students get the chance to work with students at a variety of developmental levels and put their new knowledge and skills to use in the classroom. They’ll also attend seminars and document their progress with a weekly reflective journal and an accumulative portfolio.

The program is offered via online courses, giving candidates the convenience and flexibility to complete it whenever they have time and at their own pace. Program graduates are eligible for New York State certification as a TESOL teacher for PreK-12. Students can transfer up to 12 credits from previous graduate-level study toward our requirements, and students who have completed Touro’s  Advanced Certificate in TESOL  may apply their credits toward the Master's degree.

The Touro Graduate School of Education MS in TESOL is a great way to advance your teaching career and sharpen your skills to better reach the ever-growing population of multilingual learners in the New York area and beyond. To learn more about the program and how you can apply, contact us today!

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Sources of stress and coping strategies among Chinese medical graduate students: a qualitative study

  • Yanhao Zhang 1 ,
  • Xiaoli Lin 1 ,
  • Lina Yu 2 ,
  • Xue Bai 2 ,
  • Xiangyu Li 2 &
  • Wenfei Long 2  

BMC Medical Education volume  24 , Article number:  624 ( 2024 ) Cite this article

Metrics details

The incidence of mental health problems among medical graduate students is much higher than among students of other disciplines. This can have adverse consequences for the medical students themselves as well as their future patients. This study aims to understand the pressures faced by Chinese medical students and the current status of mental health education. It also propose recommendations for the current situation and prospects for the future.

The authors conducted in-depth semi-structured interviews with 22 master’s students from five medical schools during November 2023. All interview sessions were recorded and transcribed verbatim. The transcriptions were analyzed using the Colaizzi’s seven-step method.

Three main themes were extracted from the students’ statements: sources of psychological stress, ways to cope with stress, and perspectives on mental health education. The study showed that current mental health education in China is mostly in the form of printed mental health education manuals and mental health lectures, and there is no active tiered intervention for students at different levels. It is suggested that reforms should be made to shift to a model where the school proactively identifies problems and intervenes based on feedback.

This study reveals the widespread psychological stress and shortcomings in current education methods. To address these challenges, institutions should develop tailored interventions, including tiered support systems, open dialogue promotion, and resilience training. Future research should focus on evaluating innovative interventions’ effectiveness, ultimately fostering a supportive environment that enhances students’ success and contributes to a healthier healthcare workforce.

Peer Review reports


Stress is viewed as a state of real or perceived threat to homeostasis [ 1 ]. Chinese medical graduate students face challenges such as longer academic years and high clinical pressures [ 2 ]. Research has shown that the overall prevalence of depression among medical students globally is 28.0% [ 3 ], with Asian students having a depression rate of approximately 38.0% [ 4 ]. In studies conducted in the Chinese national knowledge Infrastructure (CNKI) database, the proportion of students engaging in health-risk behaviors due to stress was as high as 42.33% [ 5 ]. The incidence of suicidal ideation among medical students in mainland China is 11.73%, surpassing that of medical students in the United States (11.2%) [ 6 , 7 ]. However, only 12.9% of depressed medical students who experienced stress and exhibited health-risk behaviors sought treatment [ 3 ]. Over the past three years, amidst the global COVID-19 pandemic, the mental health challenges faced by Chinese medical students have become more pronounced [ 8 , 9 ]. Existing research on medical student stress primarily focuses on cross-sectional surveys of student anxiety, depression, and related psychological abnormalities, with relatively little research on how medical students cope with stress and alleviate resulting health issues. Current research on stress among medical students mainly focuses on cross-sectional surveys of anxiety, depression, and related psychological abnormalities. Unfortunately, there is limited research on how medical students can cope with stress and alleviate the resulting health issues caused by stress. As future clinical practitioners, medical postgraduates under stress may potentially engage in substance abuse and increase the risk of irreversible harm, such as medical errors [ 10 , 11 ]. Urgent attention from educational institutions, society, and the government is needed to address the mental health of Chinese medical students. Additionally, scholars have emphasized the importance of enhancing medical students’ psychological resilience and strength.

Moreover, enhancing the psychological resilience and strength of medical students is particularly crucial. Some researchers have improved students’ stress resistance through methods such as autonomous training, progressive muscle relaxation, and Mindfulness-Based Stress Reduction (MBSR) [ 12 , 13 , 14 , 15 , 16 , 17 ]. These experiences may shed light on the direction of mental health education for Chinese medical students. Therefore, this study aims to propose an initiative to increase awareness of mental health education for medical graduate students by understanding the various pressures they face, mechanisms for reducing stress, and the acceptance of mental health education. It also suggests providing personalized psychological adjustment methods for this population and designs references for interventions to improve graduate students’ mental health for society, government, and universities.

The present study revolves around the formulation of interview guidelines based on positive psychology theories. Educational psychology is the scientific study of the fundamental principles governing teaching and learning within educational environments [ 18 ]. Positive psychology primarily aims to stimulate and strengthen individual reality and latent capabilities, leading to the development of positive personality traits [ 19 ]. These traits, in turn, facilitate individuals in adopting more effective coping strategies. We conducted semi-structured interviews with 22 medical postgraduate students of Chinese nationality who were enrolled in medical or related programs at six universities across three countries. Data collection, organization, and analysis were completed between November and December 2023. All study materials were reviewed by the Ethics Committee of Guangdong Provincial Hospital of Chinese Medicine, and all participants provided informed consent.

The researchers and participants

We formed a qualitative research team consisting of six members. The team included a university professor specializing in medical education, two doctors engaged in clinical psychology work, and three research postgraduate students (two in nursing and one in psychology). Initially, we extensively reviewed relevant literature on positive psychology theories to develop a draft of the semi-structured interview guidelines. Two clinical doctors conducted preliminary interviews using the draft guidelines with four eligible research postgraduate students, making revisions to the guidelines. The revised guidelines were then handed over to the university professor for further modifications, leading to the final version. Three research postgraduate students were responsible for data collection and organization, while the analysis stage was a collaborative effort involving the entire research team.

We employed convenience sampling to recruit participants for this study, ensuring that there would be a good rapport between interviewers and interviewees, enabling open and honest expression of their thoughts and feelings. The inclusion criteria for participants were as follows: (1) enrollment in a medical graduate program at a university or a comprehensive university with a medical major; (2) good communication skills, and clear verbal expression, absence of mental disorders; (3) informed consent and voluntary participation in the study. Exclusion criteria included individuals who had already graduated, taken a leave of absence, dropped out, or failed mid-term assessments. Out of the 22 interviewees, 20 were enrolled in Chinese universities, while two were studying in foreign universities. Their ages ranged from 22 to 27 years old, with nine being male and 13 being female. The participants were pursuing master’s degrees, and 15 (68.2%) came from middle-income families. Please refer to Tables  1 and 2 for specific details.

Data collection

Interviews were conducted with eligible participants using a pre-established semi-structured interview guide. Prior to the interviews, we explained to the participants the purpose and methodology of the study, assuring them that their privacy would be respected, and their personal information would not be disclosed. Participant numbers instead of real names were used during the interviews. We also followed the principle of convenience for the participants, agreeing on suitable interview times and locations to ensure a confidential, quiet, and undisturbed environment throughout the interviews.

During the interviews, we obtained informed consent from the participants, and if any doubts or concerns were raised, we immediately halted the interview. We fully respected the participants’ willingness to express themselves and refrained from evaluating the viewpoints they presented. Instead, we enriched the overall research process by using timely probes and follow-up questions. In order to capture accurate information, we recorded the conversations using two recording devices, while carefully observing the participants’ facial expressions and emotional changes, making authentic records of the interview process.

Interview guide

Brief introduction of yourself.

A detailed description of your current state, including mental and physical ones.

Description of sources of stress in life and ways to relieve them.

Perspectives on approaching the future about study and career.

Perspectives on mental health education. The forms of receiving mental health education and desired future of receiving mental health education.

Data analysis

The interview will be transcribed into a computer file within 24 h after the interview is concluded. Then, the interviewee and one researcher within the team will manually verify and reorganize the transcribed data to ensure that the interviewee’s statements are not misunderstood or distorted. Two graduate students will then use the Colaizzi [ 20 , 21 ] 7-step analysis method to analyze the reorganized interview data: (1) Read the data repeatedly to fully understand the interviewee’s statements; (2) Identify meaningful statements word by word; (3) Encode recurring viewpoints; (4) Collect codes to form common concepts. After completing these four steps, the two graduate students will exchange opinions and accept or delete the formed codes and common concepts. In cases of significant disagreement, a third graduate student will join to make a joint decision in order to minimize the biases caused by the analysts’ subjective intentions. (5) Elaborate on the common concepts and incorporate typical descriptions provided by the interviewee. After completing the fifth step, the elaborated concepts and the interviewee’s typical descriptions will be reviewed by professors from relevant medical schools within the research team to eliminate the narrow analysis resulting from the analysts being graduate students themselves. (6) Construct themes; (7) Provide the obtained themes to the interviewee to ensure the authenticity and accuracy of the results.

According to the interviewee’s statements, three themes emerged:

Sources of stress for medical graduate students: The interviewees highlighted various factors that contribute to their stress levels during their studies.

Ways to alleviate stress for medical graduate students: The interviewees shared helpful approaches they employ to manage and reduce stress in their lives.

The importance and necessity of mental health education. The interviewees emphasized the importance of mental health education in medical graduate programs to support the well-being of students.

To maintain anonymity, each interviewee was assigned a unique number instead of disclosing their identities.

Sources of stress for medical graduate students

Medical graduate students face pressure from multiple sources. According to the interviews, they reported increased pressure compared to their previous stages, such as undergraduate studies or work. Additionally, different groups of students, based on academic years and admission methods, experienced varying levels of stress, suggesting different layers of pressure.

Stress from economic concerns

The pressures faced by medical graduate students primarily stem from economic concerns. These pressures can be attributed to two key factors. Firstly, medical students experience a prolonged duration of study compared to their peers, resulting in a delayed achievement of financial independence. While their same-aged counterparts may have already established themselves economically, medical students remain dependent on financial support. This discrepancy in financial status creates significant stress for medical graduate students. Secondly, the economic pressure experienced by medical students is further influenced by their family’s financial situation. For those from financially constrained backgrounds, the burden of financial responsibilities and expectations can be particularly overwhelming. Balancing academic demands with financial obligations adds to the already demanding nature of medical education.

N2: Compared to my peers, they have already achieved basic financial independence and no longer rely on their parents for living expenses… As my parents get older, I feel more pressure than before. N11: There will be financial pressure, and I really want to be able to earn my own money because many of my friends have started working and earning salaries, which makes me anxious. N22: I haven’t graduated yet, and I estimate that it may take me another year to graduate, which means I will be close to 30 by then. The (financial) pressure is quite high, and most of my peers have already bought cars, houses, and gotten married, while my graduation seems to be far off.

Stress from academic studies

Academic pressures also significantly impact medical students, with sources of stress varying between academic years. In lower academic years, students may experience stress due to a lack of clarity and direction regarding their research projects. This ambiguity can lead to uncertainty and anxiety about their future career path. In contrast, middle and upper academic years are faced with the pressure of producing and publishing research papers. The successful completion of these papers is vital for their academic progress and can significantly impact their career prospects.

N15: During the graduate stage, there are more things to consider compared to the undergraduate stage. It involves writing research papers, and in terms of research, one is just beginning to delve into it and there is a lot that one doesn’t understand. This can lead to feelings of anxiety. (Lower academic years) N6: Can’t help but think too much and do too little when it comes to writing research papers and the pressure to continue pursuing a PhD in the future. (Middle academic years) N20: The current pressure is to quickly meet the graduation requirements and revise my thesis. (Delayed graduate student)

Stress from interpersonal relationships

In addition to the factors mentioned earlier, interpersonal relationships play a significant role in putting pressure on medical students, especially in their interactions with supervisors, peers, and clinical preceptors. The dynamics in these relationships can contribute to higher stress levels. One specific group that faces intensified interpersonal pressure is individuals transitioning from clinical practice to an academic setting. Compared to their counterparts with no prior clinical experience, these individuals often encounter more challenges in navigating interpersonal relationships. The increased pressure can stem from various sources, with the loss of personal privacy being a prominent factor. In the learning environment, which requires close collaboration, feedback, and evaluation, personal boundaries are breached, leading to feelings of vulnerability and heightened stress.

N9: I feel like there is a hierarchical relationship with my advisor, so I am afraid to communicate with them, fearing that I might say something wrong and disappoint them. (About advisor) N12: It feels like a job, with a superior-subordinate dynamic, where I have to say what they want to hear, even if it means telling lies constantly. (About advisor) N5: It’s lonely being a graduate student. Even when my roommate is in the dorm, we don’t have much in common, and I feel a strong sense of distance between people. (About classmate) N17: It’s difficult to develop a close relationship with my roommate. When I return to the dorm, it feels like I’m invisible. I find a secluded corner, sit down, and live in my own world (About classmate). N4: I don’t like the atmosphere in the department, and the management style of the head nurse is suffocating (About clinical mentor). N18: When nursing graduate students are in clinical practice, the level of expertise and technical skills of the clinical instructors is inadequate. Some of the theoretical lectures provided by the instructors cannot keep up with the pace of progress in nursing and may be outdated. (About clinical mentor)

The career development of medical graduate students is a topic of great concern and pressure. They often face the decision of choosing between working in clinical settings, pursuing further academic studies, or taking on non-clinical positions related to medicine. Our research indicates that nursing graduate students in particular show some aversion towards clinical work. This aversion may stem from concerns about emotional burnout and job-related stress. However, it is important to recognize that these concerns are not unique to nursing students but are likely shared by medical students in different disciplines. The findings highlight the need to support medical students in making informed career decisions, while also prioritizing their personal well-being and self-care. Moreover, promoting the exploration of non-clinical opportunities and expanding the scope of medical training can offer valuable alternatives for medical students. The COVID-19 pandemic has significantly impacted medical students, with school and hospital lockdowns and restrictions generating substantial pressure. The implementation of measures such as social distancing, personal protective equipment protocols, and limitations on clinical placements can cause significant disruptions to medical education and clinical training. However, it is noteworthy that the pandemic has also increased public recognition and appreciation for healthcare workers, including medical students. This recognition has the potential to improve medical students’ sense of professional identity and increase their sense of purpose. The outpouring of support and recognition strengthens medical students’ connection to their career choice, motivating them to persevere despite the associated challenges.

Strategies for medical graduate students to cope with stress

Medical students often turn to exercise to relieve stress and express their emotions, while seeking very few alternative methods. However, the current stress relief options available to them are limited, focusing predominantly on extroverted emotional release. Interestingly, during interviews, none of the respondents mentioned the utilization of introverted strategies to enhance their psychological resilience and inner strength.

N1: (Ways to relieve stress) Talking to the advisor and exchanging ideas with senior colleagues in research. Additionally, relaxing activities like going back to the playground for a run or listening to music and watching dramas. N3: Facing the problem directly, even if not following the planned schedule, gradually completing tasks. I also accept feedback from friends, reflect on myself, and might adopt their perspectives. N6: Venting out emotions. There must be an outlet, not keeping everything inside. N21: Currently, there may not be many ways to alleviate the situation, so it’s essential to face the stress head-on. Dealing with graduation-related issues can indeed be urgent.

Mental health education of medical students

Medical students recognize the significance of mental health education for themselves as well as for diverse social groups and communities. Currently, psychological education for medical graduate students is primarily delivered through online campaigns, offline lectures, and distribution of psychological health handbooks. However, both in terms of format and significance, it has not met expectations.

N1: With the development of society, every individual faces numerous psychological health issues. Therefore, I believe that psychological health education is highly necessary. N11: Not only graduate students, but individuals from various social strata and age groups all require it. Psychological health education is highly necessary. N2: Currently, mental health education is primarily conducted in classrooms. The information is diverse, and when we enroll or before classes, we are shown short films on mental health education and provided with brochures on the topic. N4: I prefer a more entertaining form of education, with more activities. I enjoy interactive formats as they tend to be more engaging and fun, rather than just lectures. N6: Mental health education should not be about someone telling me what to do, but rather me sharing my thoughts with them. They can then identify the conflicts in my mind and help resolve my troubles. Ultimately, it would be beneficial to have personalized guidance tailored to each individual’s specific concerns. Currently, mental health education for medical students tends to be formalistic and does not effectively address their mental health issues. However, medical graduate students are eager to receive psychological education that allows them to actively participate and acquire practical skills to cope with these issues. They prefer a more interactive approach rather than just lectures. N6: It is indeed very formalistic. Even if you express your concerns, they won’t solve them. They may not even be aware of the issues students are facing… When responsible teachers come to our dormitory, it feels like a leadership inspection, just going through the motions, very formalistic. Mental health education should not be about someone telling me what to do, but rather me sharing my thoughts with them. They can then identify the conflicts in my mind and help resolve my troubles. Ultimately, it would be beneficial to have personalized guidance tailored to each individual’s specific concerns. N14: I personally would not go to those psychological counseling offices set up for students. If I have psychological issues, I would rather seek help elsewhere. I feel like it’s just for show. N18: I don’t like the form of lectures or public accounts. They just copy some PPTs and course materials online, which are useless, and students don’t pay attention to them at all. N4: I prefer a more entertaining form of education, with more activities. I enjoy interactive formats as they tend to be more engaging and fun, rather than just lectures.

Source of stress and ways students cope with

The essence of the research, conducted through semi-structured interviews, reveals that medical graduate students face various common sources of stress. Initially, transitioning from undergraduate to graduate status induces a sense of discomfort. Heinen’s study identifies that stress among medical students in their first year correlates with personal resources and emotions [ 22 ]. Furthermore, delayed financial independence compared to peers is a stressor, as most students rely solely on family support due to the demanding clinical and research workload [ 23 ]. This mirrors the situation in many Western countries. In Su’s study, it was found that a good supervisor-graduate student relationship can enhance the positive impact of psychological capital on graduate students’ professional commitment [ 24 ].

Meanwhile, this study explored the current methods employed by medical graduate students to alleviate stress. Exercise is one common approach; it allows medical students to release inner emotions and improves both physical and mental well-being, consequently enhancing their daily academic and professional performance. Research indicates a dose-response relationship between lack of exercise and adverse mental health outcomes, including self-harm and suicide attempts, highlighting the necessity of promoting physical activity among university students [ 25 ]. Additionally, music serves as a common relaxation method for students. Linnemanna’s research found that music can alleviate daily stress for students, aligning with the positive direction advocated by positive psychology theories [ 26 ]. However, due to long working hours, these coping mechanisms cannot always be guaranteed, and the study suggests that only a minority can strengthen inner psychological resilience and strength through these strategies.

Psychological education is one of the crucial measures to promote the mental health of medical graduate students [ 27 ], primarily achieved through: (1) curriculum education; (2) regular lectures and workshops by experts or experienced physicians; (3) distribution of mental health materials both online and offline; (4) resources such as online videos, applications, etc.; (5) personalized guidance tailored to individual personalities and needs [ 28 ]. Currently, psychological education for medical graduate students in China mainly consists of online activities, offline lectures, and distribution of mental health handbooks. Most students hold a negative attitude towards the methods and approaches employed in school psychological education, perceiving it as primarily formalistic during the graduate stage, with limited practical significance. Limited by the fact that funding for Chinese universities and research institutions mainly comes from national financial subsidies, attention and resources for students’ mental health tend to be overshadowed by support for research and clinical work, making personalized guidance even more challenging. In fact, in the interaction between mentors and students, the relationship tends to be more hierarchical rather than educational and guiding, neglecting the role and influence teachers should have. As the primary person responsible for students’ academic and personal development, mentors’ neglect and students’ resulting self-isolation and reluctance to communicate lead to a sense of disconnection between both parties, depriving students of a means to build a healthy psychological environment. Research indicates that whether mentors provide appropriate support can significantly impact students’ academic output [ 29 ], potentially related to the incentives and pressures mentors face in their positions. Due to the heavy academic workload and limited free time, graduate students receive fewer resources for mental health assistance, contributing to the persistent and severe mental health issues among medical graduate students in China.

Current approaches to supporting students’ mental education

The psychological state is a constantly changing process, and relying solely on a single psychological test at the beginning of the school year to measure students’ psychological state throughout the entire learning period is insufficient. Schools must increase their focus on students’ mental health and consider it as important as academic performance. We should conduct extensive research to identify the differences in issues faced by graduate students at different stages and use this information to determine timely psychological interventions at different time points.

The results of this study indicate that academic pressure, financial stress, and interpersonal relationship pressure are common stressors among medical graduate students. For academic pressure, pre-entry education is necessary to help students transition from undergraduates to graduates and avoid confusion about their learning lives. Therefore, recommendations for introductory professional books and career development literature can be made during graduate admissions, along with introductions to upcoming course plans and schedules. Additionally, under the background of the “Internet Plus” era, early online meetings and collaborations with senior students can also help newcomers integrate into the new environment [ 30 ].

The study found that most graduate students rely on family financial support. Although China has implemented a standardized training system for physicians, graduate students are in a blind spot of the system and currently cannot receive standardized training rewards, even though these rewards can only ensure basic survival for doctors. Therefore, it is necessary to improve the working conditions of medical graduate students [ 31 ]. In this study, interpersonal relationship stress mainly comes from the relationship between graduate students and their mentors. Mentors should pay more attention to students’ mental health rather than just their academic performance and work. The graduate stage should be a process where teachers and students jointly research scientific problems [ 32 ], rather than just focusing on outcomes, which may lead to teachers only caring about students’ research results and neglecting the cultivation process.

There are clear differences in mental health issues among graduate students. Tailored psychological education for different groups based on their characteristics is the key to addressing the current psychological health education for medical graduate students, rather than mere formalism. For special groups, such as those returning to campus from clinical work, assigning them to the same dormitory to unify their schedules as much as possible could be beneficial. Although assigning separate dormitories can address privacy concerns, it may not be fair to other graduate students. The premise of solving the problem is to minimize the emergence of new problems. For students who delay graduation, we could assign them a new graduation advisor to reduce their psychological pressure effectively.

Future measures to enhance students’ mental education

Research has found that psychological issues among graduate students, particularly in the field of medicine, are significant social concerns. Despite the challenges posed by academic, financial, and social pressures, these pressures are regarded as essential aspects of personal development, shaped by societal realities. However, external measures can only rectify issues after they arise, making it imperative for graduate students to cultivate strong resilience and coping mechanisms to mitigate negative emotions. Thus, enhancing proactive self-adaptation abilities among graduate students is crucial for stress alleviation [ 33 ]. Moreover, prioritizing prevention over treatment as graduate students’ psychological issues evolve into mental illnesses underscores the importance of establishing robust mechanisms for early detection and intervention within educational institutions, supported by governmental policies and funding. Educational institutions should provide scientifically effective intervention models, including the implementation of positive tiered interventions based on continuous feedback loops, fostering a culture of open dialogue and support for mental well-being. Integrating psychological education courses and practical resilience-building activities into existing curricula is essential. On the other hand, increasing parents’ understanding of graduate student mental health issues is essential [ 34 ], enabling guardians to recognize the pressures faced by graduate student groups, especially in identifying abnormal psychological and behavioral changes in their children, which is also one of the important forces for early detection and prevention of graduate student mental health issues.

Building upon these recommendations, society should actively assume corresponding responsibilities. Under government guidance, strengthening collaboration between universities and social institutions to establish a mental health counseling service system in society is crucial [ 35 ]. Establishing a diverse collaborative network is a complex and winding process. Establishing a comprehensive medical graduate student psychological education system within universities requires understanding and tolerance from families, concrete actions from schools, and strong support from government and society.


Although this study focuses on current medical master’s students, their perspectives, as learners, may not fully consider the practical feasibility within the real-world context. In subsequent research, we look forward to incorporating insights from educators involved in medical master’s student mental health education to ensure maximal safeguarding of students’ mental well-being within existing conditions and without compromising the well-being of other demographics.

Several strategies for addressing mental health challenges among medical master’s students are proposed in this study. Unfortunately, apart from enhancing students’ self-psychological resilience, other recommendations tend towards macro-level interventions. These findings require extensive empirical validation and cooperation from all stakeholders. In subsequent research, we aspire to adopt more specific measures, as only a plethora of testable ideas can gradually enrich the discourse surrounding mental health education for medical master’s students.

This study underscores the urgent need for comprehensive mental health support among medical graduate students in Chinese campuses. The results reveal the prevalence of psychological stress within this group and the inadequacies of current mental health education methods. Themes such as identified sources of stress, students’ coping strategies, and perspectives on mental health education provide valuable insights for addressing these challenges. Looking forward, it is recommended that educational institutions develop proactive mental health interventions tailored to the diverse needs of medical students. This includes establishing positive tiered interventions based on continuous feedback loops, fostering open dialogue, and promoting a culture supportive of mental health. Additionally, integrating practical coping skills training and resilience-building activities into the curriculum can enable students to more effectively manage internal stressors. Furthermore, future research efforts should focus on evaluating the effectiveness of innovative mental health interventions, such as peer support programs and online mental health resources. Longitudinal studies tracking the mental health outcomes of medical students can offer valuable insights into the sustained impact of intervention strategies. By prioritizing mental health education and implementing evidence-based interventions, we can create a more supportive and resilient environment for medical graduate students, ultimately enhancing their academic success and professional development. This not only benefits individual students but also contributes to cultivating a healthier and more effective workforce in healthcare.

Data availability

The data that support the findings of this study are available from the authors upon reasonable request and with the permission of authors.


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This research was funded by Traditional Chinese medicine Bureau of Guangdong Province. Zhen Sun conducted interviews for this study. Shuhan Li provided coding assistance. We appreciate the support from the nursing team at the second affiliated hospital of traditional Chinese medicine.

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Zhang, Y., Lin, X., Yu, L. et al. Sources of stress and coping strategies among Chinese medical graduate students: a qualitative study. BMC Med Educ 24 , 624 (2024). https://doi.org/10.1186/s12909-024-05603-y

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