Dietetic Competencies Research Articles

Achieving Dietetic Competencies: Progression of Dietetic Students Using the Future Education Model

Achieving Dietetic Competencies: Progression of Dietetic Students Using the Future Education Model

Dietetic Students’ Perceptions of Learning Professional Competencies with Four Simulations Throughout a Semester

In nursing and medicine, taking part in simulation activities has been shown to be beneficial for students' learning; however, little has been documented in dietetics. This study aimed to document the perceived effect of 4 simulations on development of professional competencies by dietetic students. A mixed-method convergent approach was used with pre- and post-questionnaires, interviews, and a focus group discussion to look at dietetic students' perceptions of learning as part of a Nutrition Assessment course. Nonparametric tests for questionnaires and theme analysis for transcripts were used to examine data. After analysis, data were compared and merged for interpretation. Results showed that participants perceived a significant increase in comprehension of various competencies with simulations. In interviews and a focus group, a participant subgroup (n=7) perceived an enriched understanding of some dietetic competencies compared with pre-simulations. Simulations seemed to have transformed classroom concepts to a more practical understanding of dietetic practice. More studies are needed to identify if these results could be replicated in different settings. Simulations had a positive effect on students' perception of competencies development and may be an andragogical tool of choice to support preparing future dietitians for entry to practice.

Developing National Conceptual Understanding to Describe Entry-to-Practice Dietetics Competence

ObjectiveDevelop consensus on entrustable professional activities (EPAs) and milestones for students, practice educators, and academics that need shared understanding to assess entry-level competence in dietetics. DesignAn iterative, pragmatic, 3 key-phase approach involving workshops, a consensus survey with job description and consultation. SettingAustralia. ParticipantsA total of 58 academics and 43 practitioners with expertise in competency-based assessment in dietetics were purposefully selected to participate in 4 national workshops. Of those selected, 36 completed a survey that sought consensus on the EPAs and milestones drafted at the workshops (36% response rate). Phenomenon of InterestSupport for competency-based assessment. AnalysisLevel of agreement on the survey was set at ≥70%. These comments were triangulated with content analysis from 98 entry-level job descriptions. ResultsConsensus on 4 key tasks of the profession with associated descriptions of the level of performance were included to implement a nutrition intervention; facilitate a food, nutrition, and/or lifestyle conversation; perform professional activities and projects; and work as part of a team. Conclusions and ImplicationsIdentification of the key minimum tasks of a dietitian upon entry-to-practice, together with developmental descriptors of performance, provides clarity in the expected progression and end point of assessment. This resource will support competency-based assessment decisions. The international transferability of this warrants further investigation.

Participating in Faculty-Supervised Extracurricular Experiential Learning Activities Contributes to Dietetic Competency Development.

Purpose: To examine the relationship between Food and Nutrition graduates' involvement in faculty-supervised extracurricular experiential learning activities (FEEs) and the development of dietetic competencies. Methods: An original web-based survey, assessing involvement in FEEs and self-perceived level of Canadian dietetic competencies, was administered to Brescia University College Food and Nutrition graduates for graduation years 2011-2017. Competency scores were calculated for each respondent in 4 practice areas (Professional Practice, Communication and Collaboration, Population and Public Health, and Management), and summed for a Total Competency Score. Multiple linear regressions were used to assess predictors of competency scores. Results: The final sample consisted of 233 respondents who participated in 1.9 ± 1.1 FEEs. The highest average competency score (out of 100) was Communication and Collaboration (59.7 ± 31.7); the lowest was Management (40.3 ± 30.9). Total hours spent and breadth of experiences in FEEs were significant predictors of all scores (P < 0.05). Depth of experiences was a significant predictor of all competency scores (P < 0.05) except for Management (P = 0.27). Conclusions: Participation in FEEs contributes to Food and Nutrition students' development of entry-level dietetic competencies; therefore, counting some FEEs as curricular credits may be warranted. Given the prominence of competency-based learning assessments, these results also have implications for faculty resources, budgets, and collective agreements.

P22 Development of Cultural Competence in Dietetics and Nutrition Students: Is Cultural Humility the Missing Link?

Background Cultural competence is a key component of dietetics and nutrition curriculum due to the increase in diversity in the United States. Few studies have been completed in the dietetics and nutrition field to determine best practices in curriculum development to increase cultural awareness and competence of students. Objective The purpose of this study is to determine dietetics and nutrition faculty perceptions of their students’ cultural competence and to determine best practices for educating and training students to become culturally competent professionals. Study Design, Settings, Participants Seven dietetics and nutrition faculty were interviewed about their perceptions of cultural competence in students and their thoughts on how to best deliver cultural competence training to students. Interviews were conducted using an in-depth, semi-structured interview process and were recorded with permission of the participant. Measurable Outcome/Analysis The interviews ranged in length from 19-40 minutes. Interviews were transcribed verbatim and resulted in 58 pages of transcripts. During the transcription process, the investigator engaged in a constant comparative method of data analysis and axial coding. Results The importance of cultural humility emerged as a prominent theme throughout the interviews with dietetics and nutrition faculty. Subthemes of cultural humility included communication and sharing, encounters and opportunities, continual reflection and lifelong process. Faculty discussed the importance of students communicating with individuals from a different culture throughout the curriculum. Faculty and students sharing also emerged as important throughout the curriculum. Encounters with individuals from different cultures and faculty arranging opportunities for students to engage in cross-cultural interactions emerged as an important subtheme. Lastly, faculty frequently discussed the importance of cultural competence being a lifelong process. Conclusion Cultural humility is missing from current cultural competence frameworks and should be considered as an additional construct to the current cultural competency framework and added to the curriculum for dietetics and nutrition students. Funding None.

Teaching Future Dietitians Leadership: A General Needs Assessment

The needs of the patient population are characterized by more chronic or complex health problems and the health care delivery system is constantly undergoing transformation. While discussions among stakeholders about changing the health system are essential, there is a concurrent need to focus on health professions education. There is a need to understand how entry-to-practice standards are used to develop health professions curricula. Based on recent stakeholder consultations and workforce assessments conducted by Dietitians of Canada and provincial interest groups, an emerging area of dietetic competency appears to be leadership. The purpose of this research project was to gain a better understanding around how competency standards are utilized to develop health professions curriculum, with a focus on dietetic curriculum related to management and leadership. To meet this objective, a general needs assessment was conducted using five databases: CINAHL, PubMed, FSTA, Scopus, and ERIC. The ancestry method was incorporated with purposive sampled articles to find additional research articles. The following key terms were included in the search: health professions, dietetics, nutrition, management, leadership, education, curriculum, competency, entry-level. A review of the literature indicates that developing professional competencies in leadership can strengthen some health professionals’ capacity to take on certain roles through competency-based education. In addition, the long-term training effects result in an increase in specific competencies relevant for effective interprofessional collaboration. There is opportunity for pedagogical and practice-based activities to strengthen leadership abilities of future dietetic professionals.

Moderation of a foodservice assessment artefact in nutrition and dietetics programs.

Foodservice is a key component of dietetics education and practice internationally yet benchmarks for competency are limited. This study sought to review and moderate an assessment artefact of foodservice work integrated learning (WIL) to develop a shared understanding of one tool which may be used in a suite of evidence to demonstrate competence. The foodservice curricula and assessment artefacts were described for the foodservice program at each of four participating universities. An assessment artefact from WIL, the report, was identified as an indicator of foodservice competence common to each program. Each university provided four purposively sampled WIL reports, assessed in duplicate by two academics from other participating universities using the corresponding university assessment rubric. Collated assessment results, along with the original assessment, were presented back to assessors. A semi-structured group discussion explored variations in assessment results, factors influencing decisions, and potential changes needed for assessment documentation. There was variation in assessment outcomes between independent assessors. In some instances assessors did not consistently deliver the same assessment outcome, nor rank students in sequential order of performance. This variation was less where an absolute ranking of satisfactory/unsatisfactory was applied. The assessor discussion revealed three key concepts: importance of understanding the project scope; challenges which influence assessment decision making; importance of understanding the broader program of assessment. Assessment inconsistencies emphasise the importance of multiple assessors and assessment artefacts across a programmatic assessment model, and the need for a clear understanding of competence in nutrition and dietetics.

Elevating Dietetic Interns' Competency and Confidence through Simulation Using a Standardized Patient and Objective Structured Clinical Examination

Elevating Dietetic Interns' Competency and Confidence through Simulation Using a Standardized Patient and Objective Structured Clinical Examination

Programmatic Assessment of Competence in Dietetics: A New Frontier

Programmatic Assessment of Competence in Dietetics: A New Frontier

A Reflection on Cultural Competence: A Dietitian's Didactic Discourse

This paper makes the case that cultural competence is a key part of dietetic practice and in turn dietetic education. With a breadth of studies on cultural competence in dietetics and health care, the human, relational component hasn’t been emphasized. To this end, this paper makes the case for a holistic view of clients, patients and all of those who fall under the care and guidance of dietitians. And further, for practitioners to work with a notion of self-reflection to develop a disposition that is attuned to culture. Pedagogical implications and curricular applications are included as a result of this inquiry while concepts from Sikhism are offered as illustrative components to highlight this reflection on cultural competence.

Growing professional competence in nutrition and dietetics

Growing professional competence in nutrition and dietetics

Training Dietetic Interns to do Outcomes Research/Management using Community-based Participatory Research

Abstract: Dietetic Interns (DIs) need effective supervised practice opportunities to apply the principles of program development, implementation, evaluation, and particularly, outcomes management. Outcomes management tracks data to improve practices, outcomes, effectiveness and efficiency. The Nutrition Care Process guides outcomes management in dietetics. Merging it with Community-based Participatory Research (CBPR) can insure more appropriate and sustainable outcomes and processes. Syracuse University’s dietetic internship provides a concentration in outcomes management. Through a three-credit graduate class, DIs learn CBPR, specifically the PRECEDE-PROCEED model. The model covers how to collaborate with their community, collect/analyze data, design an objective-driven outcomes management project, and to marshal available resources for meeting the identified health needs of the community. A preceptor and advisory panel collaborate with a team of DIs for each project. This paper describes the structure of the class used to teach DIs to do outcomes management using CBPR. DIs and graduate students completed a survey designed for this research, which assessed their perceptions of the effectiveness and their satisfaction with the class, rotation/experience, and the barriers, benefits and lessons learned using CBPR. Although participants found learning and implementing PRECEDE-PROCEED to be complicated, they rated the experience as effective for: 1) building appropriate entry-level dietetic competencies, 2) collaborating with the community and 3) designing effective and sustainable outcomes management projects. They were satisfied with their abilities, effort and outcomes. The benefits, challenges and proposed improvements for the experience and training are discussed.

Building bridges in dietary counselling: an exploratory study examining the usefulness of wellness and wellbeing concepts.

Over the last decade, professional discourse around health ownership has been evolving to recognise an individually-driven wellness/wellbeing approach. Concurrently, dietetic competencies have changed to include client-centred counselling incorporating individual client's perspectives within dietary prescriptions. The present exploratory research aimed to explore how client-centred counselling practice was being represented in the dietetic literature and to examine dietitians' perspectives about working with clients in the current environment. To explore the professional position, a literature search was conducted using keywords encompassing client-centred care and competency within professional dietetic journals (2001-2010). To develop a contextual case study, 10 in-depth interviews with dietitians delivering weight-loss prescriptions within a clinical trial were conducted. Recordings of their perspectives on roles, opportunities/barriers and counselling strategies were transcribed verbatim and examined using inductive thematic and content analysis. Eleven articles were incorporated into a narrative review describing practice issues related to traditional forms of consultation and the effectiveness of client-centred approaches. The over-riding theme from the interviews (Professional Identity Dilemma) highlighted tension felt by dietitians in their dual role as nutrition expert and counsellor, trained to deliver biomedical imperatives (clinical targets), and their challenge to accept client-defined health perspectives. Supporting themes (Adherence factors and Constructs of health) exposed details on barriers to dietary change and the impact of contextual factors on this change that were linked to wellness and wellbeing concepts. Appreciating wellness and wellbeing concepts may add a useful adjunct to client-centred approaches to dietary counselling through building bridges between clinical targets and client health perspectives.

The Role of Dietitians in Providing Guidance: On the Use of Natural Health Products

Dietitians are experts on nutrition, and yet much uncertainty remains about their readiness and capacity to address a rapidly evolving marketplace of novel foods, nutrients, and nutrient-like substances (i.e., natural health products [NHPs]), which are available to consumers. In 2011, we conducted a qualitative examination of current thinking on the scope of practice, as well as barriers to and facilitators of dietitians' role as experts in providing guidance on NHP use. We sought rich descriptions of existing and future dietetic competencies with NHPs. We therefore conducted six focus groups. Participants were 18 dietitians practising in rural settings and 21 practising in urban settings of Atlantic Canada. Themes identified included people, products, and information; future education and training underlay these themes. The "food first" philosophy of dietetics practice was a primary convergent theme, the consensus being that NHPs can be used for select populations, lifestyles, and health conditions. The less food-related the NHP, the more divergent opinions were on specific competencies and scope of practice; focus group participants often referred to the importance of "doing no harm" and evidence-based practice. Dietitians' achievement of competency in providing guidance on NHPs will require core, consistent, and cross-disciplinary information and competencies, as well as enhanced integrative practice models.

Training Dietetic Interns to Do Outcomes Management Using Community-Based Participatory Research

Dietetic Interns (DIs) need effective supervised practice opportunities to apply the principles of program development, implementation, evaluation, and particularly, outcomes management. Outcomes management tracks data to improve practices, outcomes, effectiveness and efficiency. The Nutrition Care Process guides outcomes management in dietetics. Merging it with Community-based Participatory Research (CBPR) can insure more appropriate and sustainable outcomes and processes. Syracuse University's dietetic internship provides a concentration in outcomes management. Through a three-credit graduate class, DIs learn CBPR, specifically the PRECEDE-PROCEED model. The model covers how to collaborate with their community, collect/analyze data, design an objective-driven outcomes management project, and to marshal available resources for meeting the identified health needs of the community. A preceptor and advisory panel collaborate with a team of DIs for each project. This paper describes the structure of the class used to teach DIs to do outcomes management using CBPR. DIs and graduate students completed a survey designed for this research, which assessed their perceptions of the effectiveness and their satisfaction with the class, rotation/experience, and the barriers, benefits and lessons learned using CBPR. Although participants found learning and implementing PRECEDE-PROCEED to be complicated, they rated the experience as effective for: 1) building appropriate entry-level dietetic competencies, 2) collaborating with the community and 3) designing effective and sustainable outcomes management projects. They were satisfied with their abilities, effort and outcomes. The benefits, challenges and proposed improvements for the experience and training are discussed.

APPLICATION OF LEAN METHODOLOGY PRESCRIPTION OF NUTRITION SUPPLEMENTS ASMEDICATION BY DIETITIANS

In a major Victorian hospital, dietitians observed that requests tomedical staff to prescribe nutritional supplements via themedication chart were inefficient. This led to delays in the deliveryof nutritional recommendations, thus compromising patients’nutritional status. Lean Methodology was applied to simplify theordering of patients’ nutritional supplements as medication(NSAM) by dietitians. A literature review was conducted. Directobservation and value stream mapping were used to identifyprocess time and wasted time related to NSAM prescription. Adetailed root cause analysis of identified issues was undertaken,followed by the development of an implementation plan. Thefollowing problems were identified: ordering process wascomplicated and not linear, delay in patient receiving NSAM (2.8days, range 0–23 days), and 60% repeat requests by the dietitian forNSAM. An implementation plan was developed which included:submission to the Medical Executive Committee to seekprescribing privileges for dietitians; dietetic competency trainingand credentialing, communication strategy, development ofprescribing and administering procedures; and ward education.Dietetic prescribing privileges were granted, implemented, andevaluation of this change in dietetic practice undertaken. Inconclusion, application of Lean Methodology enabled dietitians toclearly examine, in a systematic manner, delays, risks andinefficiencies with our current process of ordering NSAM. It led toa plan of action to improve quality of care to our patients, includingrenal patients, and reduce waste in our health care setting by timelyand appropriate commencement of NSAM.

Cooking skills are important competencies for promoting healthy eating in an urban Indigenous health service

AbstractAim: A recent article in this journal asked whether cooking should be a dietetic competency and recommended finding dietitians’ views on the use of cooking skills interventions as nutrition education. This article presents views about the value of cooking skills in the work of nutrition professionals and students working in an urban Indigenous health service.Methods: We reflect on our experience facilitating a series of practical cooking workshops in adult Aboriginal and Torres Strait Islander groups and the importance of cooking skills for professionals promoting nutrition in community contexts.Results: Cooking skills were essential for facilitating practical workshops to promote healthy cooking and eating among urban community groups. The workshops provided participants with new cooking ideas, opportunities to cook new recipes and some unfamiliar ingredients as well as learning new cooking skills. These enabled participants to be more confident preparing healthy meals at home. Cooking skills enhanced the processes of both effective community engagement and nutrition promotion.Conclusion: Cooking interventions make an important contribution to promoting nutrition in urban Indigenous contexts and cooking skills are therefore important competencies for nutrition and dietetic professionals delivering practical community nutrition programs.

Mixed methods research approach to the development and review of competency standards for dietitians

AbstractAim: Competency standards support a range of professional activities, including the accreditation of university courses educating health professionals. Reviewing these standards is essential to ensure universities continue to produce well‐equipped graduates, who are able to meet the challenge of changing workforce requirements. This paper has two aims: (a) to provide an overview of the methodological approaches used for compilation and review of the Competency Standards for Dietitians and (b) to evaluate the Dietitians Association of Australia's Competency Standards and capture emerging and contemporary dietetic practice.Methods: A literature review of the methods used to develop competency standards for dietitians in Australia, including entry‐level, Advanced level and Dieticians Association of Australia Fellow competencies and other specific areas of competency, such as public health nutrition and nutrition education, is outlined and compared with other allied health professions. The mixed methods methodology used in the most recent review is described in more detail.Results: The history of Dietetic Competency Standards development and review in Australia is compared with Dietetic Competency Standards internationally and within other health professions in Australia. The political context in which these standards have been developed in Australia and which has determined their format is also discussed. The results of the most recent competency standards review are reported to highlight emerging practice in Australia.Conclusion: The mixed methods approach used in this review provides rich data about contemporary dietetic practice. Our view supports a planned review of all competency standards to ensure practice informs education and credentialing, and we recommend the Dietitians Association of Australia consider this in the future.

Should cooking be a dietetic competency?

AbstractAim: There are issues surrounding the apparent decline and devaluing of cooking skills in the population, potential health impacts and the role of dietitians. The present paper aims to outline several arguments and raise questions on the relationship between cooking and dietetics.Methods: Evidence from dietetics and nutrition journals and other sources is used to develop positions for dietetics and its relationship to cooking and cooking skillsResults: The historical relationship between dietetics and home economics has seen dietetics professionally distance itself by its scientific education on food and nutrition, rather than actual involvement with cooking. In pursuing this rational scientific approach there are concerns that dietitians have inadvertently supported the growth of the functional and convenience food market, particularly given the demise of home economics as a skill‐based curricula in schools in several states. There is a need to consider what role cooking skills could have in dietetics training as a professional competency for practice, particularly for public health interventions. This is in the light of Commonwealth government funding that is legitimising cooking skill interventions as a policy response to obesity. There may be a role for dietitians to develop partnerships and train a new professional category or paraprofessionals and/or peer educators to deliver cooking skill interventionsConclusion: There is a need for research on dietitian's views and use of cooking skill interventions. This would help answer whether we should consider cooking and cooking skills as part of our professional practice and whether cooking should be a dietetic competency.

The Challenge of Skill Transfer: Dietitian Perspectives

The notion of transferable skills is part of the comprehensive education model for dietetic practice. Dietitians' perspectives were collected to determine their understanding of the concept and which dietetic skills they considered transferable in long-term and acute care environments. The study included a purposive sample of 14 dietitians representing long-term and acute care internship training and employment. The dietitians completed a questionnaire and were interviewed. All respondents demonstrated an understanding of the concept of transferability of skills. Results indicated that the majority believed dietetic entry-level competencies could be achieved in both long-term and acute care environments. While the majority believed competencies could be transferred from one environment to another, issues were raised about transfer from long-term care to acute care. These issues included limited client communication, fewer resources, and less opportunity for exposure to skill areas. Interpretation of the term "skill," one-way transferability, and level of competence required for the particular working environment emerged as challenges to operationalization of the concept. Transferability of skills within dietetic practice requires further investigation if it is to be fully understood and used to its full potential.