Regional variations in medical trainee diet and nutrition counseling competencies: Machine learning-augmented propensity score analysis of a prospective multi-site cohort study



Medical professionals and students are inadequately trained to respond to rising global obesity and nutrition-related chronic disease epidemics, primarily focusing on cardiovascular disease. Yet, there are no multi-site studies testing evidence-based nutrition education for medical students in preventive cardiology, let alone establishing student dietary and competency patterns.


Cooking for Health Optimization with Patients (CHOP; NIH NCT03443635) was the first multi-national cohort study using hands-on cooking and nutrition education as preventive cardiology, monitoring and improving student diets and competencies in patient nutrition education. Propensity-score adjusted multivariable regression was augmented by 43 supervised machine learning algorithms to assess students outcomes from UT Health versus the remaining study sites.


3,248 medical trainees from 20 medical centers and colleges met study criteria from 1 August 2012 to 31 December 2017 with 60 (1.49%) being from UTHealth. Compared to the other study sites, trainees from UTHealth were more likely to consume vegetables daily (OR 1.82, 95%CI 1.04-3.17, p=0.035), strongly agree that nutrition assessment should be routine clinical practice (OR 2.43, 95%CI 1.45-4.05, p=0.001), and that providers can improve patients’ health with nutrition education (OR 1.73, 95%CI 1.03-2.91, p=0.038). UTHealth trainees were more likely to have mastered 12 of the 25 competency topics, with the top three being moderate alcohol intake (OR 1.74, 95%CI 0.97-3.11, p=0.062), dietary fats (OR 1.26, 95%CI 0.57-2.80, p=0.568), and calories (OR 1.26, 95%CI 0.70-2.28, p=0.446).


This machine learning-augmented causal inference analysis provides the first results that compare medical students nationally in their diets and competencies in nutrition education, highlighting the results from UTHealth. Additional studies are required to determine which factors in the hands-on cooking and nutrition curriculum for UTHealth and other sites produce optimal student — and, eventually, preventive cardiology — outcomes when they educate patients in those classes.

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The authors have no relevant financial disclosures. The authors would like to gratefully acknowledge the dedicated medical school, college, and hospital administrators, community members, medical professionals, and trainees who made this intervention possible to build healthier communities, together. Additionally, the authors are indebted to the remaining CHOP co-investigators: Dr. Darrin D’Agostino, Dr. Keith Argenbright, Dr. Jaclyn Albin, Dr. Milette Siler, Dr. Dennis Muscato, Dr. Louise Muscato, Rachel Bross, Dr. Nadia Aibani, Dr. Holly Johnson, Dr. David Martins, Dr. Barbara Tangel, Dr. Alyse Van Lieu, Dr. Sheryl Harnas, Dr. Ann Andrada, Dr. Eugenia Edmonds, Dr. Jeremy Beer, Dr. Tisha Lunsford, Dr. Margaret Kim, Dr. Irma Hasham, Dr. Debra Stulberg, Dr. Katherine Palmer, Dr. Jennifer Boryk-Ratner, Dr. Tomi Dreilbelbis, Dr. Shannon Kelleher, Dr. Richard Streiffer, Dr. Jennifer Clam, Dr. Jeannine Lawrence, Dr. Linda Knol, Dr. Melanie Tucker, Dr. John Higginbotham, Dr. Joan Han, Dr. Chantis Mantilla, Dr. Patricia Griffin, Dr. Lindsey Grant, Dr. Caroline Compretta, Dr. Loretta Jackson, Dr. Rob Karch, Dr. Rosemarie Lorenzetti, Dr. Konrad Nau, Dr. Mike Finan, Dr. Connie Cooper, Dr. Laurie Macaulay, Dr. Elaine Chen, Dr. John Billimek, Dr. David Kilgore, Dr. Beverly Wilson, Dr. Suzanne Bertollo, Dr. Shreela Sharma, Dr. Laura Moore, Dr. Deanna Hoelscher, Dr. Lawrence Deyton, Dr. Seema Kakar, Dr. Chris D’Adamo, Dr. Deborah Cohen, Louise Merriman, Dr. Kristen Mathieson, Dr. Emily Rosenthal, Dr. Swana De Gisel, Dr. Roma Gianchandani, Dr. Brigid Gregg, Dr. Dianne Habash, Dr. Farzaneh, Dr. Lori Whelan, Jennifer Newton, Dr. Ashley Bunnard, Dr. Tanmeet Sethi, Dr. Ala Shaikhkhalil, Dr. Rebecca Mathews, Dr. Ann Langston, Dr. Carolyn Nichols, Dr. Sharon Moore, Dr. Lisa Hamilton, Dr. Laura Robertson-Boyd, Dr. Leanne Mauriello, Dr. Lora Boroff, Dr. Kate Swanic, Dr. Kelly Fackel, Dr. Jim Schoen, Dr. Josie Elrod, Dr. Rebecca Collins, Jill Gallin, Annie Sanford, Dr. Daniel Fry, Gina DeVito, Dr. Leonard, Walsh, Dr. Evan Siau, Dr. Glenn Mack, Dr. Joan Hendrix, and Dr. Jonathan Woodward. Furthermore, the authors are indebted to those who provided their support, Ms. Elise LeBovidge.

Statement of Contributions

C.M.C. and D.M. designed the research study and analyzed the data. J.W., D.H., A.D., L.S., and T.H. conducted research and provided critical review. A.P. wrote the paper. J.T., H.B., A.N., T.D.N, and A.M. are responsible for the final content.

Funding disclosures

The implementation of the Health meets Food curriculum at UTHealth was funded by the Nourish Program at the UTHealth School of Public Health and the Michael & Susan Dell Center for Healthy Living.


Funding is provided by the Nourish Program.

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Correspondence to Anish Patnaik.

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Ethical Approval was provided by Tulane IRB Proposal.

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Informed consent was provided by all participants in the trial.

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Patnaik, A., Tran, J., McWhorter, J.W. et al. Regional variations in medical trainee diet and nutrition counseling competencies: Machine learning-augmented propensity score analysis of a prospective multi-site cohort study. Med.Sci.Educ. 30, 911–915 (2020).

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  • Machine learning
  • nutrition
  • medical education
  • public health
  • medical student