How can hospitals best meet the learning needs of children who experience health-related schooling disruptions? In recent years, this question has attracted significant attention. Increases in the number of hospitalized children and the spread of whole-child-centered approaches to care have combined to prompt a reconceptualization of hospitals as alternative learning spaces.

One example of this is "Science Journeys." Launched in 2022 by the Children's National Research Institute, Science Journeys seeks to provide children and families in hospitalized settings with high-quality STEM educational opportunities. The project's facilitators guide hospitalized children through hands-on learning activities that aim to increase STEM literacy, improve physical and mental health, and equip them with the skills and tools needed to promote agency in their personal health journeys.

In support of these goals, at the project's outset, we undertook a review of recent scholarly literature on hospital-based education for children with complex, ongoing health conditions. In addition to clarifying the social, psychological, and academic challenges that come with hospitalization, our review shed light on the role that hospital-based education can play in meeting these challenges — and on the kinds of learning activities that are most effective in helping ensure hospitalized children's continued academic progress.

What Did We Find?

Our findings indicate that the most effective forms of hospital-based education are those that:

Preserve Children's Identities as Learners

Medical conditions that cause frequent absences from school can result in declining academic performance. Hospitalized children often feel that they are "falling behind" academically, and their disconnection from school-based learning environments can lead to a loss of interest in learning. All of this underscores the importance of activities that ensure continuity in education throughout children's illness experiences. By embedding learning into healthcare practices, hospitals can boost children's self-esteem and motivation — both of which are prerequisites for academic achievement.

Impart a Sense of Normalcy

Chronic illness and its treatment can cause children to develop a negative self-image and a sense of themselves as being different. Because of this, hospitalized children "need as many normalizing experiences as possible" — that is, things that show them they can have a normal life despite their illness. By promoting forms of learning that support "active participation in normal life experiences," hospitals can help children with chronic illnesses develop a positive outlook on life and a positive sense of self-worth — all of which helps them manage life around their conditions.

Center Mental Health and Emotional Wellbeing

In addition to placing a tremendous burden on children's bodies, chronic illnesses are often accompanied by psychological and emotional stressors. When others see them as "sick," children may lose important friendships and experience social isolation. Prolonged hospitalization can contribute to feelings of loneliness; indeed, research dating back to the 1970s has shown that depression and anger rank among the most common impacts of lengthy hospital stays on school-aged children. But hospital-based education can help reduce the anxiety, fear, and sadness many children with chronic conditions confront. A recent report found that engaging in learning during periods of hospitalization is associated with a stronger desire to survive, an ability to come to terms with one's condition, and with optimistic, future-directed thinking.

Let's Put it to Work!

Hospital-based learning can be highly beneficial for children. It shows that those around them "are committed to providing them with the future they deserve by affording them the opportunities to realize their potential." How can hospital-based educators "transform the negative and harmful experience of a child's medical condition into a formative and empowering voyage through life"? In what follows, we offer three suggestions on how to put the above points into practice.

Create Personalized Learning Experiences

Historically, hospital-based education has sought to prevent children from "falling behind" by creating a learning environment that mimics classroom contexts. This largely remedial approach to learning is often both impractical and detrimental. Rather than attempting to replicate school-based classroom settings, educators can instead look for ways to create personalized learning experiences for hospitalized children, designing programs and activities that engage their wants and needs, and that meet them where they are — "irrespective of prior learning experiences". By tailoring instruction to their lifeworlds and their clinical realities, hospitals can foreground children's identities as learners, thus preventing the onset of negative attitudes and preserving a sense of normalcy.

Encourage Children to Take Control of Their Learning

In addition to responding to children's interests and concerns, hospital-based education should encourage them to take agency over their learning. A helpful framework here is that of self-regulated learning (SRL), which emphasizes ways children can shape and contribute to their own cognitive development. Instead of seeking to equip children with particular subject-matter knowledge, the goal of SRL is to foster the acquisition of transferable skills — that is, skills that are useful across all subjects, like goal-setting, time management, problem solving, or self-questioning. A recent study found that SRL-based approaches to hospital education are effective not only in distracting children from their conditions, but also in helping them master new skills.

Prioritize Psychological and Emotional Wellbeing Over Academic Performance

For parents, caregivers, and hospitalized children alike, one of the biggest concerns attached to chronic illnesses is learning loss. To prevent this, what's needed is a form of education that reduces feelings of isolation, anxiety, and the sense of difference that many hospitalized children feel. By designing lessons and activities that allow them "to do things as they might outside the hospital setting," educators can normalize children's hospital experiences and prevent them from feeling that they are "missing out." It is for this reason that so many researchers recommend the use of laptops and other digital devices within hospitals. Information and communication technologies such as email, video chat, social media, computer games, and online learning programs can go a long way toward improving the emotional well-being of hospitalized children, and existing studies provide strong support for their incorporation into hospital-based educational programming.

About This Article

This article is part of our ongoing evaluation of the informal STEMM learning programs created by Children's National Research Institute. To learn more about how we've worked with Children's over the years, see our partnership landing page. Click here for some early findings from our evaluation of Science Journeys. And to learn about earlier iterations of this project, see our blog posts on "Discover SCIENCE with Doctor Bear" — including our overview of this project and our investigation into its role in breaking racial barriers in STEMM education

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