TwoOldGuys™ e-Publishing
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“eNutrition 101, Nursing flavor”
Assessment of Student Learning


TwoOldGuys™ eNutrition 101, Nursing Flavor is an effective means for your students to learn the basic concepts of Nutrition Science, and the practical application of this knowledge to the practice of Nursing. The Final Exam was a term paper reporting the results of a Case Study in which each student analyzed the nutritional value of a different actual patient's diet and suggested ways to improve the patient's diet to promote Wellness. The Case Study grade distribution was as follows:
        {A = 53%;  B = 21%;  C = 2%;  D & F = 24%},
suggesting that those who learned from the course, learned well. On the other hand, those who learned less, learned very little.

Participation, defined as number of contacts for the semester, as an estimate of the extent to which the student followed the stated procedures was distributed as follows:
        {more than required = 44%;  minimum required = 2%;  less than required = 31%;  much less than required = 23%}
The Case Study grade distribution was correlated [significant at the 95% confidence level] with Participation, supporting the conclusion that those students who complete the course work learn. The regression line:
        (Case Study) = 1.95 times (Participation) + 26.09,
mathematically describes the predictive value of Participation for determining Case Study scores.


The TwoOldGuys™ eNutrition course has been designed to implement my teaching methods [which are ‘non-traditional,’ and have been called ‘constructivist’] in a web-based environment. This course is described as “independent study” rather than as an “on-line course,” because it consists entirely of written ‘lectures’ (adapted from my in-class lecture notes, with references to the textbook) and ‘quizzes’ (focused on the key topic(s) of the lecture as it applies to the Nursing profession). Students are expected to read the lectures, then answer the essay question(s) on the quizzes using the textbook and other sources (print or on-line). Some of the quizzes are ‘discovery’ exercises, in which the students must conduct a brief independent study to discover the principle underlying the concept. The better students understand that this implies directed [by the lecture content] independent research on Nutrition topics. Based on comments solicited from students for assessment, all of the students who have taken other on-line courses agree that this course is “unlike any other on-line course I have taken.” But, is different necessarily a good thing? After all, traditional methods of teaching seem to have done an adequate job of meeting the underlying purposes of Liberal Arts College education, which are
        (a) to transfer Knowledge from the professor to the students,
        (b) to have the students learn in such a way that they can apply this newly acquired Knowledge to Real World situations, and
        (c) to help the students develop Critical Thinking skills and apply these skills for problem solving.

    We have anecdotal evidence that the design of TwoOldGuys™ eNutrition 101 may facilitate student learning. During a recent semester, 31 of 31 students who provided feedback were strongly positive about their perceived learning (selected examples of student feedback can be found at comments on eNutrition 101). However, as a well-educated person accustomed to using Critical Thinking, you are no doubt skeptical about anecdotal evidence. Obviously, the examples were selected to portray our product in a favorable light; and are therefore merely “testimonials from satisfied former students.” Why should you expect anything less than an ‘academic assessment,’ held to the standards of clinical trials, to verify that student learning can be expected from an innovative approach to pre-requisite courses for your Nursing program? We think the answer should be “You should expect to see scientific testing of the premise that our eNutrition 101 course is an effective means for your students to learn the basic concepts of Nutrition Science, and the practical application of this knowledge to the practice of Nursing.”
    This document is a summary report of an academic assessment of our approach to on-line learning, based on all students enrolled in the course for the 2010 school year at one participating College. We assume that extensive assessment of traditional in-class instruction has shown that an acceptable level of learning occurs. Since there has been a striking increase in the number of on-line course offerings, it may be reasonable to assume further that assessment for accreditation purposes has confirmed the effectiveness of the current industry norm for on-line courses. However, TwoOldGuys™ eNutrition does not follow the industry norm, so we must demonstrate that Student Learning results when students follow the course procedures.


The students were assigned a Case Study, in which they selected a patient and tracked their diet for seven consecutive days, accounting for all food consumed. They then analyzed the nutritional value of the patient's diet, using Thompson Learning's Diet Analysis +™ software. The results were described in a term paper along with recommendations for changing the patient's diet to improve the patient's Wellness. This Case Study requires the student to use all of the cognitive skills in Bloom's Taxonomy, except for the lowest of these skills, "remembering." The term papers were evaluated (on a scale of 0 to 100) to assess ‘Learning,’ defined as the extent to which each student had applied the concepts of Nutrition using a proper term paper format and reasonably correct grammar. These data were assigned to groups based on the grading scale for the College.

Other data used for the assessment included “attendance,” defined as a minimum of one e-mail contact per week; “participation,” defined as the total number of e-mail contacts for the semester; and “quizzes,” defined as the percent of possible points on quizzes and exercises. These data were used to determine the extent to which the amount of learning could be predicted from the effort the students devoted to the course. Since it is an “independent study” course, one would expect to see a strong relationship between student effort and learning.

Data and Analysis

    An important point which needs to be stressed is that 74% of the students taking the TwoOldGuys™ eNutrition course in 2010 earned a grade of B- or better on the term paper describing the Case Study! Only 24% of the students earned an F or D. Clearly, we are doing something right to cause Learning to occur.
    The distribution of the Case Study scores is bimodal, with modes at A and F,
has a range of 0 to 99, with the median at 90 (A-),
and a mean at 71.6 (C) with standard deviation of 37.0.
While this does not match the ‘traditional’ grade distribution curve [which portrays the population as a symmetrical, bell-shaped curve centered on a C], on every occasion when I have have looked at the distribution of grades for populations of Community College or underclass University students [in their first two years at university], I have found the distribution to be bimodal – usually with the primary mode at about B to B+, and the secondary [smaller] mode at C to D. The present distribution is, then, unusual in the sense that the primary mode is slightly higher [at A] and the secondary mode is lower [at F], with a gap between the two groups represented by these modes; suggesting that the amount of Learning in the ‘independent study’ environment depends on different parameters than does Learning in the face-to-face, in-class environment. The challenge becomes the identification of those parameters which drive Learning in the independent study environment, so we can exploit these parameters to assure that the maximum amount of Learning is possible.

    Attendance was defined by the College to be a minimum of “one contact with the instructor per week” for independent study students. Since the semester was sixteen weeks long, the maximum possible attendance score is 16. However, we believe that it is redundant to impose a penalty for poor attendance at College, because failure to attend an in-class course is self-penalizing; students who attend class ought to get higher grades than students who do not attend [when I have looked at this for traditional in-class courses, the correlation has been either significant at the 95% confidence level, or “almost” significant (80% or 90% confidence)].
    While “attendance” for independent study students seems almost to be an oxymoron, it is a requirement by the College (site of data collection for this study) that all instructors report attendance for all classes, including ‘independent student check-in's’ each week. Since these data exist, we can use them as a reasonable first approximation of the effort that the independent study students were willing to commit to the course.

    This distribution is skewed, with a mode at 15,
has a range of 0 to 16, with the median at 12,
and a mean at 10.8 (C) with standard deviation of 4.5.
The Student grades (calculated as 50% quiz percent of total possible points and 50% the term paper) are significantly correlated with Attendance (r = 0.758 compared to the critical value of 0.381 at the 95% confidence level). [It should be noted that turning in quizzes is a form of contact, so a student who turned in one quiz per week (2 are assigned each week) would have 16 for Attendance, but would be able to earn no more than 75.0% (C+) by turning in perfect quiz answers for 50% of possible quiz points, and a perfect term paper for 100%.] We can conclude that independent study students who contact their instructor as required get better grades than those who do not. The fewer weeks during which contact is made, the lower the final grade. No additional, artificial penalty for failure to contact the instructor is warranted.

    Participation was measured as the number of contacts by the student for the semester, with a minimum ‘expected’ value of 28 [25 quizzes, 1 final term paper, and 2 weeks without assignments due]. Also included in the Participation count were any questions or other e-mail contacts. These data were grouped into 0 to 5, 6 to 10, 11 to 15, ... 46 to 50, and 51 to 55. The premise is that by forcing the students to think about the Nutrition concepts covered in the lecture, the quizzes serve to reinforce learning and to move the Knowledge to long-term, working memory.

    This distribution is bimodal, with a modes at 27.5 and 2.5,
has a range of 0 to 54, with the median at 26.5,
and a mean at 24.3 with standard deviation of 11.6.
The Case Study scores are significantly correlated with Participation (r = 0.628 compared to the critical value of 0.381 at the 95% confidence level). The regression line is
        (Case Study) = 1.95 times (Participation) + 26.09,
which mathematically describes the predictive value of Participation for determining Case Study scores. We can conclude that the course design causes learning.
However, the gap in Case Study scores between the group represented by the upper mode and the group represented by the lower mode suggests strongly that self-discilined students should learn well, while the undisciplined students may learn little or nothing from the course. There was no ‘middle ground’ between the two extremes. This also implies that the course is sufficiently demanding to meet the curriculum needs for even the most rigorous programs.
It is important to note how the Case Study and resulting term paper compares to the cognitive skills from Bloom's taxonomy:

Bloom's Taxonomy of cognitive skills
as utilized in Case Study
Case Study
Creating must design a diet to correct key problems
Evaluating must evaluate (triage) which nutrients are
most deficient or most excessive
Analysing must analyze patient's diet
Applying must apply virtually everything learned from this course
to an actual case study
Understanding must understand the concepts to complete the above
Remembering not applicable
(can look up factual information, as needed)


TwoOldGuys™ eNutrition 101 (Nursing flavor) was shown to provide an excellant opportunity for students to learn the concepts of Nutrition as they relate to the Nursing profession. This conclusion was supported by statistical testing of student learning outcomes at a two-year Liberal Arts college with a Nursing program. Students can also gain experience with applying Nutrition concepts to promoting Wellness as a Nurse in the role of patient advocate. However, because the course is ‘independent study,’ and on-line without face-to-face meetings with the instructor, the student must have the self discipline required to follow the course procedures in order to take advantage of the learning opportunity.
    This course is sufficiently demanding to meet the curriculum needs for even the most rigorous programs.

Appendix: course description from formal assessment report

TwoOldGuys™ eNutrition is designed to meet the following:
    1. This course is designed for the independent study student, and will allow the student to learn enough about the principles of Human Nutrition to assess the nutritional status of a real patient based on their diet, and to make recommendations which should promote increased Wellness for the patient. [The Nursing ‘flavor’ of TwoOldGuys™ eNutrition was designed specifically to provide the Nursing population with a foundation in Nutrition as a means of increasing Wellness. The lectures speak directly to the Nursing applications of Nutrition Science. With frequent references to the physiology of Nutrition, the course reinforces knowledge gained from Anatomy & Physiology while making the course content more relevant to the students. Textual illustrations of the concepts of Nutrition Science tend to emphasize the Nurse-patient interaction, portraying the Nurse in the roles of patient advocate and/or patient educator.]
    2. The student will develop the ability to think critically and communicate effectively in written form.
The students who have met the goals will be expected to exhibit the following:
    The student will be able to analyze the diet of an actual patient, to explain the nutritional adequacy of the diet, and to explain how the diet can be modified to promote a higher level of wellness for the patient.
    The student will provide a term paper to the instructor illustrating how they have achieved the intended student learning outcomes, by the beginning of finals week.
In order for the student to create the term paper, the student was required to participate in a case study, for which the student was to select a patient, and track the patient's diet over seven consecutive days accounting for all food intake. These data were to be entered into software [Thompson Learning's Diet Analysis +™] designed to convert the food to a listing of the nutrients in the food compared to current recommended intake of these nutrients. The case study was introduced to the student along with the rationale for why this study meets the intent of the effort to assess Student Learning Outcomes: “The assessment and recommendations will require you to apply virtually everything you are expected to learn from this course to an actual case study.”

The rubric for evaluating the resulting term papers was
        1. Critical thinking – was the student able to limit their discussion to only 2 or 3 important issues?
        2. Rationale for selecting issues – was the student able to explain adequately why (s)he choose the issues identified?
        3. Rationale for recommendations to improve diet – was the student able to explain adequately why (s)he made the recommended changes proposed?
        4. Communicate effectively in written form – was the student able to write a properly formatted term paper?
        5. Communicate effectively in written form – was the student able to write the paper without grammatical errors?
Each of these was evaluated on a 10-point scale. In addition, the student's ability to produce a term paper by the stated deadline was evaluated on a 50-point scale. The total of these points was calculated as the Case Study Score. These data were grouped into the following classes:
0 to 59.9,   60 to 69.9,   70 to 76.9,   77 to 79.9,   80 to 82.9,   83 to 86.9,   87 to 89.9,   90 to 92.9,   and 93 to 100.


Charles R LaFrance, PhD
LaFrance Consulting Services LLC
551 Woodland Dr
Graham NC 27253

(336) 226-6875

© 2010 TwoOldGuys ™     revised: May 2010