Design-based Research Framework Research Articles

Exploring Design-Based Research as a framework for addressing pedagogical problems faced by higher education

Design-Based Research presents a pragmatic approach to addressing both pedagogical problems and innovations within a rigorous framework that aims to build transferable practice. This panel discussion will explore four examples of implementing DBR in various higher education contexts and draw participants into a discussion of how they might apply DBR to address identified pedagogical problems or innovations in their own contexts. Why DBR? This panel discussion is a focal point for exploring how design-based research (DBR) in higher education in 2024, can address pedagogical problems brought about by the global pandemic and the explosion of generative artificial intelligence use in assessment and learning (For examples). In a period of continuous disruption in higher education, flexible and ethical research strategies that embrace unexpected influences in teaching and learning is paramount (Cochrane et al., 2023), leading to a new generation of educational researchers embracing DBR. Furthermore, practical examples demonstrating students as partners in curriculum design to inform ‘what works’ in practice are essential for researchers to gain confidence in adopting research-teaching-practice methods of inquiry (Bakker, 2018; Cochrane & Munn, 2020). Understanding how the processes and outputs of DBR can meet these needs is crucial to alleviating both business and educational tensions about timing, funding, resources, and workload planning (Cochrane, 2022; McKenney & Reeves, 2019; Reeves & Lin, 2020). At the core of DBR is the opportunity to explore pedagogical problems or innovation through four phases: problem analysis, develop solutions to the identified problem, explore and evaluate the impact of the design in iterative interventions in real learning situations, leading to the development of transferable design principles and theory building (McKenney & Reeves, 2019) Various research methods can be applied to progressively ask participant perspectives, including students, teachers and learning designers, on appropriate approaches or technologies to solve an identified problem (McKenney & Reeves, 2019). The intended outcome of this panel discussion is to collaborate with participants in implementing DBR in higher education in response to specific pedagogical problems identified by the participants. Beginning with a brief background to DBR followed by four examples to stimulate discussion on its application in broader contexts to address identified problems in curriculum design. Relevance to Higher Education The relevance of debating the role of design-based research in higher education in 2024 is to stimulate discussion for how this pragmatic research approach informs ‘what works’ in situated learning contexts to develop cutting edge design principles and theory that can be transferrable (Galvin & Cochrane, 2023). The methodological framework of DBR invites students, teachers, and learning designers to collaborate from the conception of a design artefact or educational approach to solve a learning problem through to iterative stages of delivery. Following a new normal in higher education where change is inevitable, and fast-paced, research design that does not shy away from the progressive and ‘messy’ elements of educational settings to improve real time learning is essential. Finding a balance between naturalistic and interventionist research methods to explore this complexity is a way forward that DBR can provide. It is acknowledged that greater understanding for the value of DBR and how to plan practical stages with multiple participants is needed for teachers, researchers, and leaders in higher education to confidently adopt this approach (Haagen-Schützenhöfer et al., 2024). Opening discussion with peers models the collaborative ethos of DBR and opens potential connections and networking avenues to establish and generate knowledge for DBR in higher education. The Panel Members The panel will be comprised of project leaders from four DBR projects: Clinical reasoning development, interdisciplinary engineering education, biomechanics, performance anxiety. These projects were introduced in a concise paper for the ASCILITE 2023 conference (Cochrane et al., 2023) and the authors are in the process of collaborating on a full journal article analysing these DBR projects (Cochrane et al., 2024) that should be published in time for the ASCILITE 2024 conference.

Examining higher education through HyFlex

ABSTRACT This design-based research (DBR) study investigated the following research question: How can the HyFlex instructional model be leveraged to create more accessible and equitable education for graduate students? To address this question, the researchers explored two education doctoral courses in the USA, with 37 participants for one semester. The essential elements of the intervention included the following: digital, multimodal tools; equity of online and face-to-face learning environments; and engagement in community. A mixed methods approach to data collection and analysis was utilised in accordance with the DBR framework, including inhibiting and enhancing factors of the intervention, modifications made, unanticipated outcomes, and progress towards the goal. The discussion provides guidance for future implementation of the HyFlex model in higher education.

Effectiveness of a model-based inquiry instructional sequence in overcoming students’ teaching-learning difficulties on plant nutrition

ABSTRACT This work conveys the results of an iterative investigation conducted within the Design-Based Research framework. The primary objective was to develop and assess a Teaching-Learning Sequence (TLS) aimed at enhancing secondary students’ mental models about the traditionally challenging topic of plant nutrition. The design of this innovative TLS was guided by previous research and it was grounded in the Model-Based Inquiry approach as it allows to integrate scientific practices and models. To gauge the success of the TLS and contribute to the literature on the effective instruction of plant nutrition this study followed a pre–post quasi-experimental design. Thus, a preliminary (TLS1; N = 95) and a refined version (TLS2; N = 110) of the TLS were implemented and compared against a group studying through direct instruction (Control; N = 109). The analysis of the pre–post questionnaires yielded three main outcomes: (1) The results revealed that students undergoing the specifically designed TLSs attained mental models resembling the target curriculum model thereby proving their effectiveness over the control intervention. (2) The study identified salient TLS design elements (e.g. hands-on modelling, tracing matter and energy, etc.) that enriched students’ learning outcomes on the topic. (3) Finally, the findings unveiled inherent benefits of the Model-Based Inquiry approach.

Using social media platform X to enhance student medical English learning: an attempt based on design-based research (DBR) in a medical English for specific purposes (ESP) course

This study aimed to (1) elaborate on microblogging-based instruction, which was built on social media platform X and designed based on the four phases of the design-based research (DBR) framework (Amiel and Reeves in J Educ Technol Soc 11(4):29–40, https://www.jstor.org/stable/jeductechsoci.11.4.29, 2008); (2) put microblogging-based instruction into practice in a medical English for Specific Purposes (ESP) course; (3) examine students’ perceptions of the pedagogical value of X platform usage on their learning experiences; and (4) investigate how well microblogging-based instruction enhances the students’ specialised-language performance. On the basis of the four phases of the DBR framework, a study was conducted with students studying a medical ESP course to identify the problems in the teaching practices used in ESP courses. To improve the identified problems, following the second phase, social media platform X was used to supplement ESP face-to-face instruction. Three tasks were designed for the students to do on X. These tasks were implemented and assessed on 19 EFL first-year premedical undergraduate students over 16 weeks at a university in the Kingdom of Saudi Arabia. Data collected from the students included a copy version of the ESP final test, a questionnaire, and semi- structured interviews. The results revealed that X-based instruction improved students’ ability to use medicine-specialised language, offered opportunities for students to become more familiar with medicine-specific terms, perceived ability in using writing and reading skills, collaborative learning, and generated thoughtful discussions outside the confines of the classroom. However, the students’ inadequate knowledge of the specialised subject, the stress of making X mandatory, and log- in overload remain key challenges against the effective appropriation of X use in an ESP context.

Developing Teacher Competencies for Teaching Evolution across the Primary School Curriculum: A Design Study of a Pre-Service Teacher Education Module

Numerous studies indicate that evolutionary concepts can and should be taught at the primary school level. However, teaching evolution in primary school is presumably not yet the norm globally. At the same time, the educational potential of evolutionary concepts lies in their applicability to many curriculum topics in the natural and social sciences. Capitalizing on this potential requires broad teacher content knowledge (CK) and pedagogical content knowledge (PCK) about the teaching of evolutionary concepts. However, not much is known regarding ways to develop primary teacher CK and PCK during pre-service training. In this article, we present the iterative design, implementation, and mixed methods formative evaluation (based on a design-based research framework) of a pre-service teacher education module. Its aim was to promote the development of pre-service primary school teacher CK, PCK, as well as motivation and confidence for teaching evolution across the primary school curriculum. Results indicate that pre-service teachers can be supported and motivated to teach evolutionary concepts across various themes in the primary school curriculum through a semester long course. Participants were able to develop core aspects of CK and PCK regarding the teaching of evolutionary concepts in primary school. The resulting module design integrates existing collective PCK on teaching evolution at the primary level as well as novel design considerations and teaching approaches that can be integrated into pre-service teacher education programs. However, challenges remain, particularly regarding the integration of evolutionary concepts in mandated curriculum standards such that the educational potential of evolution can be fully capitalized on by teachers.

Defining the Nature of Augmented Feedback for Learning Intraosseous Access Skills in Simulation-Based Health Professions Education.

In the field of health professions education, acquiring technical skills involves three stages: 1) receiving instructions, 2) engaging in practice, and 3) receiving feedback. Simulation serves as a valuable tool that encompasses all three stages, enhancing the effectiveness of health professions education. This work focuses on feedback, which can be categorized as intrinsic (perceived by the learner through their senses) or augmented (provided by an external perspective). Augmented feedback can take the form of knowledge of results (information regarding the outcome) or knowledge of performance (information about the actions leading to the outcome). The overall objective of this work was to evaluate the perceived efficacy of these types of feedback in learning technical skills using a simulation, specifically an intraosseous access simulator, among advanced care paramedics. The primary focus of this article and the initial step towards achieving the aforementioned objective of this work was to determine the possible knowledge of results and knowledge of performance that paramedic facilitators could offer to advanced care paramedics during the use of an existing intraosseous access simulator. This research was conducted following the design-based research framework, employing a combination of design thinking and Delphi methods to generate a comprehensive list of augmented feedback, in both the form of knowledge of results and knowledge of performance, that can be provided to advanced care paramedics while learning intraosseous access skills through a simulator. The design thinking session was carried out to generate an initial inventory of augmented feedback, which was then refined through two rounds of Delphi consensus-building with paramedic experts. This process resulted in an eight-step list of feedback for knowledge of results and knowledge of performance that can be delivered to advanced care paramedics by paramedic facilitators using an intraosseous access simulator.

Interactive and social reading intervention in design-based research

This study, carried out within the design-based research framework, aimed to create a digital environment for students with learning problems to read better. The social constructivist approach was used in this study, which generally focuses on the assumption that reading is an active, interactive, dynamic, and social language skill. The instructional content, built on a learning management system, was developed in line with this strategy. Focus on the problem, understand the problem, define the design goals, outline the solution, create the solution, and test the solution stages. This results in effective and efficient digital teaching material that students with learning problems can use in their reading processes. The study clearly showed the development process of digital material, as well as a deep theoretical discussion.

Design Specifications of Augmentative and Alternative Communication Apps for Individuals with Autism Spectrum Disorder

The literature has emphasized the positive impact of mobile technologies with augmentative and alternative communication (AAC) apps for enhancing the functional communication skills of individuals with autism spectrum disorders (ASD). Although various AAC apps are available, the system design of such apps presents assorted challenges, particularly for those with ASD in different cultures. Designing useful and engaging apps by considering the affordances of mobile technologies and the characteristics of individuals with ASD may contribute to the success of interventions. In this regard, the purpose of this study is to examine the design specifications of AAC apps based on the considerations of subject-matter experts from an instructional system design (ISD) perspective. The current research employed a design-based research framework, including different methods. An AAC app named as EBA was developed by following design specifications as suggested by the field experts to answer the research questions. The results of the study revealed several enhancements in usability, flexibility, and feasibility issues of AAC apps, and highlighted the importance of (a) personalized apps, (b) simple user-interface, (c) hierarchical representation of visuals, (d) responsive apps, (e) help and documentation, and (f) parent control service. Directions for future research are proposed.

Pre-algebraic aspects in arithmetic strategies – The generalization and conceptual understanding of the ‘Auxiliary Task’

In the last decades, a broad international reform approach was visible in support of mental calculation strategies: Instead of being solely ‘transition strategies’ for learning the standard algorithms, the understanding of numerical relations is essential for mental calculation strategies, making them highly important for a viable understanding of arithmetics. Yet, mental calculation strategies are not only important for understanding arithmetics, but highly relational strategies such as the ‘Auxiliary Task’ might have an important role in the emergence of a pre-algebraic understanding of numerical relations. In this qualitative study from Germany, 4<sup>th</sup> and 5<sup>th</sup> grade learners’ (n=18) processes of interpreting the ‘Auxiliary Task’ are examined by conducting linguistic and epistemological analyzes of their conceptual understanding of the ‘Auxiliary Task’ utilizing a design-based research framework. Insights are given into specific, language-related forms of pre-algebraic generalizations of the ‘Auxiliary Task’ as well as into developmental processes within the designed learning-environment.

A Framework for Amplifying the Teaching-Research Nexus Impact: Leveraging Altmetrics via Figshare

This concise paper explores as work in progress a collaborative discussion-based webinar series that develops and amplifies understandings of the teaching-research nexus. Aimed at early and mid-career university academics, the series implements a design-based research framework using alternative publishing via Figshare and dissemination through social media networks of the recordings of live online webinars. The webinars feature a panel of invited Deans Teaching and Learning from across the university in collaboration with three higher education research specialists. Results of ongoing analysis of development, engagement, outcomes, and impact are presented, and a preliminary framework is advanced for developing and amplifying understanding of the teaching-research nexus.

Towards Describing Student Learning of Abstract Algebra: Insights into Learners’ Cognitive Processes from an Acceptance Survey

In an earlier contribution to Mathematics, we presented a new teaching concept for abstract algebra in secondary school mathematics, and we discussed findings from mathematics education research indicating that our concept could be used as a promising resource to foster students’ algebraic thinking. In accordance with the Design-Based Research framework, the developed teaching concept is now being revised in several iteration steps and optimised towards student learning. This article reports on the results of the formative assessment of our new teaching concept in the laboratory setting with N=9 individual learners leveraging a research method from science education: The acceptance survey. The results of our study indicate that the instructional elements within our new teaching concept were well accepted by the students, but potential learning difficulties were also revealed. On the one hand, we discuss how the insights gained in learners’ cognitive processes when learning about abstract algebra with our new teaching concept can help to refine our teaching–learning sequence in the sense of Design-Based Research. On the other hand, our results may serve as a fruitful starting point for more in-depth theoretical characterization of secondary school students’ learning progression in abstract algebra.

Virtual patients in clinical decision making – A design-based research approach

This paper reports on a longitudinal, design-based research (DBR) study to promote clinical decision making using a virtual patient (VP) simulation for emergency renal care. The VP was piloted with pharmacy students, then offered as an interprofessional learning exercise for pharmacy and medical students, before being introduced as part of the curriculum. In this paper, the DBR framework used to design, implement and evaluate the VP is described. The iterative changes made and implications for the integration of virtual patient simulation in the pharmacy curriculum are discussed.

Cognitive versus behavioral learning analytics dashboards for supporting learner’s awareness, reflection, and learning process

ABSTRACT Several governments across the world have temporarily closed educational institutions due to the COVID-19 pandemic. In response, numerous universities have seen a growing trend towards online learning scenarios. Thus, learning takes place not just within a person, but within and across the networks. However, the current implementations of open learning scenarios are facing many challenges, including: a) there is no systematic feature to track, evaluate and report the online learning activities of students; b) lack of immediacy and personal feedback; and c) lack of self-reflection. Consequently, Learning Analytics (LA) is one of the most distinguished solutions to address these challenges. In this study, the two kinds of LA dashboard, behavioral and cognitive, have been investigated. The methodological approach taken in this investigation was adopted from a design-based research framework, which blends empirical educational research with the theory-driven design of online learning environments. The initial sample consisted of 320 undergraduate nursing students. The cohort was divided into two groups according to the two types of LA dashboard. The findings have argued that behavioral dashboards took precedence over data evaluation items, while cognitive dashboards had the advantage in achieving the goals of LA – e.g., awareness, self-reflection, and impact on learning process.

Gamified Mobile Collaborative Location-Based Language Learning

As design-based research, this study describes the development and analysis of two location-based augmented reality (AR) serious learning games (SLG) for French second language (FL2) learning. Explorez and VdeUVic are collaborative quest-based SLGs. At different locations on campus, players interact with characters that give them quests including clues or options to further the storyline. These interactions take place in the form of either written text, or audio and video recordings, encouraging students to develop language skills both written and oral. Students choose their own learning path and advance at their own pace. Three cohorts of FL2 university students play-tested the games, with 58 of the 77 students choosing to participate in the study. The design-based research framework for the development of the game iterations and subsequent testing was an iterative process with each stage producing output that became input for the next stage. The evaluation of the AR language tools was implemented by means of a mixed-method case study, collecting data of both a qualitative and quantitative nature, through pre and post-play questionnaires, interviews, and video recordings of student gameplay interactions for analysis. Informed by situated cognition, one of the goals was to provide a contextual and immersive learning experience. Additionally, this research drew on sociocultural theory and the social nature of language learning, emphasizing learner interactions as a principal learning force. This research examined the learners’ perceptions of their learning experience, as well as the ways in which students collaborated to complete the tasks. Employing a situative approach framework informed by social regulation and content processing, student learning patterns were examined. Distinct types of learner interactions amongst teams during gameplay were shown. Patterns in the emergence of learners’ high-level co-regulation during collaborative learning are indicated in the findings. Key elements for the development and implementation of location-based serious games to foster collaborative learning are highlighted.

The AI-Atlas: Didactics for Teaching AI and Machine Learning On-Site, Online, and Hybrid

We present the “AI-Atlas” didactic concept as a coherent set of best practices for teaching Artificial Intelligence (AI) and Machine Learning (ML) to a technical audience in tertiary education, and report on its implementation and evaluation within a design-based research framework and two actual courses: an introduction to AI within the final year of an undergraduate computer science program, as well as an introduction to ML within an interdisciplinary graduate program in engineering. The concept was developed in reaction to the recent AI surge and corresponding demand for foundational teaching on the subject to a broad and diverse audience, with on-site teaching of small classes in mind and designed to build on the specific strengths in motivational public speaking of the lecturers. The research question and focus of our evaluation is to what extent the concept serves this purpose, specifically taking into account the necessary but unforeseen transfer to ongoing hybrid and fully online teaching since March 2020 due to the COVID-19 pandemic. Our contribution is two-fold: besides (i) presenting a general didactic concept for tertiary engineering education in AI and ML, ready for adoption, we (ii) draw conclusions from the comparison of qualitative student evaluations (n = 24–30) and quantitative exam results (n = 62–113) of two full semesters under pandemic conditions with the result of previous years (participants from Zurich, Switzerland). This yields specific recommendations for the adoption of any technical curriculum under flexible teaching conditions—be it on-site, hybrid, or online.

Improving Professional Decision Making in Situations of Risk and Uncertainty: A Pilot Intervention

Abstract Social workers and other professionals providing mental health services are regularly required to make high-stakes decisions in situations characterised by conflicting demands. To better understand the factors that drive clinical decision making in situations of risk and uncertainty, we used a design-based research framework to pilot a new approach for improving professional decision making. The programme, which combined simulated interviews, a master class series and personal monitoring of real-time decisions, was designed to focus explicit attention on biological, emotional, cognitive and contextual influences on decision making. Preliminary results from a pilot study suggest that during and immediately following the intervention, clinicians demonstrated new insights into their decision making processes. In addition, they reported benefitting both from the opportunity to reflect individually and share reflections with others. Physiological data demonstrated an association between stressful decisions in real-world clinical practice, elevated heart rate and emotional responses. Qualitative data suggested that client risk represented only one aspect of decision making that resulted in emotional and physical responses, and others included team dynamics, socio-evaluative stressors and organisational and societal factors. This innovative decision making programme creates new opportunities for integrating research, practice and education and shows promise of improving social work practice.

Adoption of a design-based research approach to improve understanding about complex educational problems

Over the past couple of decades, remarkable progress occurred in medical education research. However, most of the ongoing research did not seem to have added much to the existing literature. Thus, our understanding has not shown considerable improvement. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of six articles were selected based on the suitability with the current review objectives and analyzed. Design-based research targets complex educational problems in the real world, with an ultimate intention to enhance learning among the students and not justify the superiority of one teaching–learning method. In conclusion, the framework of design-based research plays a significant role in the better understanding and resolving of complex educational problems. Further, considering the encouraging results obtained in different educational problems, it is the need of the hour that all the educational researchers should adopt a design-based research approach for gaining an in-depth understanding of the local educational problems.

Designing internet-enabled patient education for self-management of T2D diabetes-The case of the Razavi-Khorasan province in Iran.

BackgroundThe number of people with diabetes is estimated to increase to 642 million by 2040, with most having type 2 diabetes. Patients with diabetes require continuous monitoring and possible treatment changes. Patient education is the process of enabling individuals to make informed decisions about their personal health-related behaviours and internet-enabled interventions have the potential to provide support and information to patients with diabetes.ObjectiveThe aim of the study was to design a portal prototype based onto two models of care and a contextualised education programme to support the self-management of diabetes patients by involving stakeholders in the Iranian province of Razavi-Khorasan.MethodsA Design-Based Research framework was adopted. A qualitative research method was used to analyse interviews with patients and care givers. Mock-ups were developed first and designed with features of user-driven and self-care models of care. The mock-ups also had adaptation features, such as for control of the disease, ability to cure self, and family support. The portal prototype was developed iteratively by building on the mock-ups and evaluated through interviews. The features and elements of the mock-ups and the portal prototype were evaluated in an outpatient diabetes clinic in Mashhad.ResultsThirty-three participants were involved in the study. The evaluation of the mock-ups resulted in two themes and seven categories: 1) self-care improvement, including self-care requirements and self-management, and 2) educational usefulness, including medical information, information mode, mobility, interaction, and efficiency. The mock-up evaluation was used as a basis for designing a portal prototype. Next, the portal prototype was evaluated, and three categories emerged from the interview data: 1) user experience, 2) functionality, and 3) interactivity. Participants were not able to prioritise between the two care models. Some functionalities of the portal could benefit from the development within a cultural context to determine differences to the best way to present material.ConclusionsA portal prototype has been designed to include two care models to support self-management and functionalities that support aspects of culture-specific diabetes self-care. This study provides guidance on developing an internet-enabled educational portal, aimed at providing support for patients in their social context.

Adoption of a design-based research approach to improve understanding about complex educational problems

Over the past couple of decades, remarkable progress occurred in medical education research. However, most of the ongoing research did not seem to have added much to the existing literature. Thus, our understanding has not shown considerable improvement. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of six articles were selected based on the suitability with the current review objectives and analyzed. Design-based research targets complex educational problems in the real world, with an ultimate intention to enhance learning among the students and not justify the superiority of one teaching–learning method. In conclusion, the framework of design-based research plays a significant role in the better understanding and resolving of complex educational problems. Further, considering the encouraging results obtained in different educational problems, it is the need of the hour that all the educational researchers should adopt a design-based research approach for gaining an in-depth understanding of the local educational problems.

Developing culturally responsive practice using mixed reality (XR) simulation in Paramedicine Education

The department of Paramedicine at Auckland University of Technology is committed to establishing informed evidence and strategies representative of all ethnicities. The MESH360 team propose that immersive mixed reality (XR) can be employed within the learning environment to introduce critical elements of patient care through authentic environmental and socio-cultural influences without putting either students, educators, practitioners or patients at risk.
 Clinical simulation is a technique that replicates real-world scenarios in a controlled and non-threatening environment. However, despite the legal and moral obligations that paramedics have to provide culturally competent care, a lack of evidence and guidelines exist regarding how to adequately integrate simulation methods for cultural competence training into paramedicine education. In our curriculum, clinical simulation has been used mainly to teach the biomedical aspects of care with less focus on the psychological, cultural, and environmental contexts. A potential, therefore, exists for high-fidelity clinical simulation and XR as an effective teaching strategy for cultural competence training by providing learners with the opportunity to engage and provide care for patients from different cultural backgrounds, ethnic heritages, gender roles, and religious beliefs (Roberts et al., 2014). This is crucial preparation for the realities of professional practice where they are required to care for patients that represent the entirety of their community.
 This presentation explores the MESH360 project and the development of a theoretical framework to inform the design of critical thinking in enhanced culturally diverse simulation clinical scenarios (ResearchGate, n.d.). The project aims to develop a transferable methodology to triangulate participant subjective feedback upon learning in high stress environments within a wide range of cultural-responsive environments. The implications for practice and/or policy are the redefinition of the role of simulation in clinical health care education to support deeper critical learning and paramedic competency within cross-cultural environments within XR.
 The aim of the research is to develop simulation based real-world scenarios to teach cultural competence in the New Zealand paramedicine curriculum. Using a Design-Based Research framework in healthcare education the project explores the impact of culturally-responsive XR enhanced simulation for paramedicine students through the triangulation of participant subjective feedback, observation, and participant biometric data (heart rate) (Cochrane et al., 2017). Data analysis will be structured around the identification and description of the overarching elements constituting the cultural activity system in the study, in the context of XR in paramedicine education (Engeström, 1987).
 Our research objective focuses upon using XR to enable new pedagogies that redefine the role of the teacher, the learner, and of the learning context to:
 
 Develop clinically appropriate and contextually relevant simulation-based XR scenarios that teach students how to respect differences and beliefs in diverse populations whose world view may be different from ones’ own.
 
 
 Inform culturally-responsive teaching and learning in paramedicine education research and practice.
 
 
 Implementation of pedagogical strategies in paramedicine critical care simulation to enhance culturally-responsive understandings and practice.