Increased competency of registered dietitian nutritionists in physical examination skills after simulation-based education in the United States.

Elizabeth Macquillan,Kristin Baird,Jennifer Ford

doi:10.3352/jeehp.2020.17.40

Abstract

PurposeThis study aimed to translate simulation-based dietitian nutritionist education to clinical competency attainment in a group of practicing registered dietitian nutritionists (RDNs). Using a standardized instrument to measure performance on a newly-required clinical skill, the nutrition-focused physical exam (NFPE), competence was measured both before and after a simulation-based education (SBE) session.MethodsEighteen practicing RDNs were recruited by their employer, Spectrum Health. Following a pre-briefing session, participants completed an initial 10-minute encounter, performing NFPE on a standardized patient (SP). Next, participants completed a 90-minute SBE training session on skills within the NFPE, including hands-on practice and role play, followed by a post-training SP encounter. Video recordings of the SP encounters were scored to assess competence in 7 skill areas within the NFPE. Scores were analyzed for participants’ initial competence and change in competence.ResultsThe proportions of participants with initial competence ranged from 0% to 44% across the 7 skill areas assessed. The only competency where participants initially scored in the “meets expectations” range was “approach to the patient.” When raw competence scores were assessed for changes from pre- to post-SBE training, the paired t-test indicated significant increases in all 7 competency areas following the simulation-based training (P<0.001).ConclusionThis study showed the effectiveness of a SBE training program for increasing competence scores of practicing RDNs on a defined clinical skill.

Highlights

Background/rationale Simulation-based education (SBE) in professional training programs has expanded in recent years [1,2]
This study examined a group of practicing registered dietitian nutritionists (RDNs) to identify changes in competence scores for clinical skills after participating in a 90-minute SBE session
The research questions were as follows: first, what is the current rate of competence in the nutrition-focused physical exam (NFPE) skill among practicing clinical RDNs?; second, are years of clinical experience, frequency of performing NFPE, and the education level of RDNs related with their initial competence scores in the NFPE?; third, does simulation-based training increase practicing clinicians’ competence in specific skills (e.g., NFPE)?; and fourth, what variables are associated with the greatest gains in competence from before to after simulation-based training?

Summary

Introduction

Background/rationale Simulation-based education (SBE) in professional training programs has expanded in recent years [1,2]. Registered dietitian nutritionists (RDNs) and graduates of dietetics education programs to demonstrate is the nutrition-focused physical exam (NFPE) [6]. As of 2017, the Accreditation Council on Education in Nutrition and Dietetics has required accredited dietetics programs to provide instruction in the NFPE [6]. Health care systems that employ RDNs are seeking training opportunities to increase utilization of this valuable clinical skill [8,9]. As a physical examination requiring physical contact with patients, a training utilizing the simulated environment and actual persons portraying patient cases (standardized patients, SPs) is an ideal pedagogical method for teaching and practice of the NFPE skill

Objectives

Methods

Results

Discussion

Conclusion