To test the hypothesis that lecturing maximizes learning and course performance, we metaanalyzed 225 studies that reported data on examination scores or failure rates when comparing student performance in undergraduate science, technology, engineering, and mathematics (STEM) courses under traditional lecturing versus active learning. The effect sizes indicate that on average, student performance on examinations and concept inventories increased by 0.47 SDs under active learning (n = 158 studies), and that the odds ratio for failing was 1.95 under traditional lecturing (n = 67 studies). These results indicate that average examination scores improved by about 6% in active learning sections, and that students in classes with traditional lecturing were 1.5 times more likely to fail than were students in classes with active learning. Heterogeneity analyses indicated that both results hold across the STEM disciplines, that active learning increases scores on concept inventories more than on course examinations, and that active learning appears effective across all class sizes-although the greatest effects are in small (n ≤ 50) classes. Trim and fill analyses and fail-safe n calculations suggest that the results are not due to publication bias. The results also appear robust to variation in the methodological rigor of the included studies, based on the quality of controls over student quality and instructor identity. This is the largest and most comprehensive metaanalysis of undergraduate STEM education published to date. The results raise questions about the continued use of traditional lecturing as a control in research studies, and support active learning as the preferred, empirically validated teaching practice in regular classrooms.constructivism | undergraduate education | evidence-based teaching | scientific teaching L ecturing has been the predominant mode of instruction since universities were founded in Western Europe over 900 y ago (1). Although theories of learning that emphasize the need for students to construct their own understanding have challenged the theoretical underpinnings of the traditional, instructorfocused, "teaching by telling" approach (2, 3), to date there has been no quantitative analysis of how constructivist versus exposition-centered methods impact student performance in undergraduate courses across the science, technology, engineering, and mathematics (STEM) disciplines. In the STEM classroom, should we ask or should we tell?Addressing this question is essential if scientists are committed to teaching based on evidence rather than tradition (4). The answer could also be part of a solution to the "pipeline problem" that some countries are experiencing in STEM education: For example, the observation that less than 40% of US students who enter university with an interest in STEM, and just 20% of STEM-interested underrepresented minority students, finish with a STEM degree (5).To test the efficacy of constructivist versus exposition-centered course designs, we focused on the design of clas...

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IntroductiondSeattle Mountain Rescue (SMR) is a nonprofit, volunteer organization that provides mountain rescue services in King County, Washington. This study analyzed the medical care provided by SMR over 14 y to understand the challenges in patient care in the region and to perform data collection and monitoring.MethodsdA retrospective review of mission reports submitted from 2004 to 2017 was conducted. Date, location, demographics, activity, callout reason, chief complaint, treatments provided, extraction means, and helicopter utilization were analyzed. Data are presented as mean±SD, with range as appropriate, unless otherwise noted. Linear regression was used to estimate changes in mission volume over time.ResultsdThere were 552 missions involving 756 subjects during the study period. Mission totals increased by 4 (95% CI 2e6, P<0.001) per year. Four locations accounted for 38% of mission volume. Subject age was 36±18 y, and 59% of subjects were male. The most common activity leading to rescue was hiking (80%). Injuries or illness precipitated 58% of callouts, whereas lost, stranded, or overdue subjects comprised 40%. For subjects requiring medical treatment, 81% involved a traumatic injury, 64% were packaged in a litter, and 35% required splinting.ConclusionsdThe frequency of mountain rescue missions in King County, Washington, has increased in the past 14 y, with traumatic injuries most frequently requiring medical care. Missing data were common in most categories, and nonstandardized reports challenged research efforts. This study provides a baseline for future research and data collection and adds to the literature regarding the medical care provided during mountain rescue incidents.