Impact of electronic health record-coaching features in weight change: A secondary analysis from the MAINTAIN-pc randomized trial.

OBJECTIVE: This study aimed to evaluate whether coaching features were successfully transmitted via electronic health record (EHR) communication and to evaluate their relationship with weight change in a previously tested EHR-based coaching intervention. METHODS: A secondary analysis from the Maintaining Activity and Nutrition through Technology-Assisted Innovation in Primary Care (MAINTAIN-pc) study randomized clinical trial was conducted in nine primary care practices and one specialty practice (endocrinology) affiliated with the University of Pittsburgh Medical Center. Eligibility included age 18 to 75 years, intentional 5% weight loss in the previous 2 years, access to an internet-connected computer, and receipt of care from a University of Pittsburgh Medical Center primary care provider. Survey data were collected during the randomized clinical trial. RESULTS: Participants content with intervention delivery via the EHR and those who felt a strong connection to their coach had significantly less weight regain (p = 0.013 and p < 0.01, respectively). Participants who had needs unmet by the intervention (e.g., "in-person" support in a group setting or individual settings) regained more weight (p < 0.01). CONCLUSIONS: The data suggest heterogeneity in the patient population regarding preference for in-person versus EHR-based coaching formats. Such heterogeneity might result in the differential success of EHR-based interventions.

The Greatest Learning Return on Your Pedagogical Investment: Alignment, Assessment or In-Class Instruction?

Critical thinking is often considered an essential learning outcome of institutions in higher education. Previous work has proposed three pedagogical strategies to address this goal: more active, student-centered in-class instruction, assessments which contain higher-order cognitive questions, and greater alignment within a classroom (i.e., high agreement of the cognitive level of learning objectives, assessments, and in-class instruction). Our goals were to determine which of these factors, individually or the interactions therein, contributed most to improvements in university students' critical thinking. We assessed students' higher-order cognitive skills in introductory non-majors biology courses the first and last week of instruction. For each of the fifteen sections observed, we also measured the cognitive level of assessments and learning objectives, evaluated the learner-centeredness of each classroom, and calculated an alignment score for each class. The best model to explain improvements in students' high-order cognitive skills contained the measure of learner-centeredness of the class and pre-quiz scores as a covariate. The cognitive level of assessments, learning objectives, nor alignment explained improvements in students' critical thinking. In accordance with much of the current literature, our findings support that more student-centered classes had greater improvements in student learning. However, more research is needed to clarify the role of assessment and alignment in student learning.