Dietetic Interns Research Articles

Training interns in nutrition and dietetics: a cross-sectional study of the barriers and motivators to being a Registered Dietitian Nutritionist preceptor

BackgroundAs is common across the health professions, training of Registered Dietitian Nutritionists (RDNs) requires experiential learning for interns/students to gain skills and demonstrate entry-level competency. Preceptors are essential to the experiential learning component of health care professional training, providing supervision and mentoring as students and interns gain the skills required for entry-level practice competency. Over the past 27 years, 47–73% of applicants to dietetic internships have received a placement. Practitioners willing to volunteer as preceptors are needed to generate more internship or experiential learning opportunities for the profession to continue to meet workforce demands.MethodsThe objective of this national-level online cross-sectional survey was to identify perceptions and attitudes associated with the preceptor role and incentives that might encourage precepting by current RDNs. A random sample of RDN and Nutrition and Dietetic Technicians, Registered (NDTR) professionals from the Commission on Dietetic Registration credentialed practitioner database were eligible to participate in the online survey. The main outcome measures included perceptions, attitudes, and preferred incentives to precept compared by preceptor experience categories (current, former, never precepted). Comparisons of perceptions, attitudes, and preferred incentives were made between preceptor experience categories using Chi-square and ANOVA.ResultsOf 2464 invitations, 308 participants had complete variables for analysis. Top incentives were the opportunity to earn continuing education units (65.9%) and having expenses paid to attend a national conference (49.5%). Significantly more (P < 0.001) “former” and “never” preceptors reported the ability to choose when to take an intern, training on how to teach and communicate with interns, and access to an “on-call” specialist as incentives compared to “current” preceptors. Significantly more (P < 0.01) “never” preceptors reported training on internship expectations and the ability to provide input on intern selection process as incentives compared to “current” or “former” preceptors.ConclusionsIncentives to serve as a preceptor differ based on “current”, “former”, or “never” precepted status. Promoting and strategizing solutions to the current imbalance between the greater number of dietetic internship applicants compared to preceptors should be targeted based on preceptor status to retain current preceptors, encourage former preceptors to return and recruit professionals who have never served.

Reflections on Covid-19 and my first dietetic internship experience

Reflections on Covid-19 and my first dietetic internship experience

Teaching in an Undergraduate Dietetics Program and Internship During COVID-19

During the spring semester of 2020, COVID-19 disrupted teaching at universities across the United States ("Coronavirus Hits Campus," 2020). Transitioning courses online presented many difficulties for instructors (Gannon, 2020; McMurtrie, 2020b; Schmalz, 2020), and educators in family and consumer sciences (FCS)–and dietetics in particular–worked to engage students, administer exams, address confusion with content, and identify alternatives for supervised practice within a very short timeframe. This paper discusses the challenges faced and solutions discovered by undergraduate and graduate dietetics program faculty at New Mexico State University (NMSU) in transitioning face-to-face courses to online. It also discusses how changes in teaching practices during this time will affect the future of dietetics education. Both programs are accredited by The Accreditation Council for Education in Nutrition and Dietetics (ACEND), which requires programs (undergraduate, graduate, and dietetic internships) to meet specific learning competencies and supervised practice hours and provide documentation that requirements are met (Academy of Nutrition and Dietetics, 2020b). Although accreditation is not unique to dietetics programs, the specific requirements, varied practice sites, and range of possible solutions merit attention.

Leveraging Online Learning to Promote Systems Thinking for Sustainable Food Systems Training in Dietetics Education.

Educating and training a multisectoral food systems workforce is a critical part of developing sustainable, resilient, and healthy food and water systems. This paper shares perspectives from a working group of educators, learners, and food systems subject matter experts that collaborated over the course of a year to develop, pilot test, and evaluate two interactive webinar series with a multi-site cohort of dietetics interns and graduate students. The three-part webinar series format included a training webinar, a practice activity, and a synthesis webinar. In reflecting on the effectiveness of this format, we provide direct assessments of student learning from subject matter experts alongside indirect assessments from pre- and post-surveys fielded with learners. Learners who participated in an interactive webinar series demonstrated skills in several dimensions of systems thinking and gained confidence in food systems learning outcomes. Learners also shared valuable feedback on the opportunities and challenges of using online platforms for this experience. As online learning opportunities become more common, it will become increasingly important for educators to prioritize strategies that effectively equip students with the higher-order thinking skills, such as systems thinking, needed to address the complexities of sustainable food systems. The interactive webinar series format described here provides an opportunity to leverage didactic webinars in combination with interactive experiences that enable learners to deepen their knowledge through practice with peers and subject matter experts. Though this format was piloted within dietetics education programs, many of the lessons learned are transferable to other food systems educational contexts.

Career Motivations and Aspirations of Dietetic Students: Applying the Social Cognitive Career Theory

Purpose: The purpose of this study was to describe the career motivations and aspirations of dietetic students using the Social Cognitive Career Theory (SCCT). The objectives were to identify and quantify 1) the factors that motivate current students to choose dietetics as a career, 2) the future career aspirations of dietetic students, and 3) the way in which dietetic students make career decisions. Methods: This descriptive study utilized the validated Career Aspirations and Motivations of Dietetics Students (CAMDS) survey. Program directors of the Accreditation Council for Education in Nutrition and Dietetics (ACEND)-accredited programs shared the CAMDS survey with their students electronically. A resulting convenience sample of n=328 students were enrolled in a didactic program in dietetics, dietetic internship, coordinated program in dietetics, or future education model graduate program. Data was captured regarding demographics, path towards a career in dietetics, motivations and influences to practice as a dietetics professional, and future career aspirations. Descriptive statistics were used to convey study findings. Data were both nominal and ordinal. Results: The majority of participants were female, white, and born after 1980. Motivating factors to pursue dietetics included cooking with family during childhood; a personal interest in nutrition; the influence of a parent or legal guardian; social media; and the opportunity to help others. The preferred employment sectors were clinical dietetics, community dietetics, and private practice. Conclusions: Attention to the career motivations and aspirations of dietetic students is requisite to supporting the growing demand for credentialed dietetics practitioners. The vast majority of current dietetic students are classified as millennials or generation Z; these students have career motivations and aspirations that are distinct from previous generations of dietetic students.

Innovative Partnerships

Nearly every country in the world faces a dual burden of nutrition-related diseases. Increased prevalence of these conditions is especially concerning in least developed countries. Training local health care professionals to administer medical nutrition therapy and apply behavior change counseling in hospital and community settings will reduce nutrition-related disease burden. We describe strategies used by Iowa State University and Oregon Health &amp; Science University and their partners in Ghana, Africa, and Lao People's Democratic Republic, Southeast Asia, to build professional capacity in clinical and community nutrition interventions and provide US-based dietetic interns and graduate students experience in the international nutrition sector.

Building a Ship While Sailing: Transition to a Virtual Dietetic Internship in Response to COVID-19

Building a Ship While Sailing: Transition to a Virtual Dietetic Internship in Response to COVID-19

Dietetic Interns’ Perceptions: Values of Clinical Rotation Tasks Contributing to Entry-Level Competency

Dietetic Interns’ Perceptions: Values of Clinical Rotation Tasks Contributing to Entry-Level Competency

Measuring the Impact of Curriculum-Integrated Librarian Instruction on Dietetic Interns’ Evidence-Based Nutrition Practice Knowledge and Behaviors

Measuring the Impact of Curriculum-Integrated Librarian Instruction on Dietetic Interns’ Evidence-Based Nutrition Practice Knowledge and Behaviors

Dietetic Interns Competency to Diagnosing Malnutrition

Dietetic Interns Competency to Diagnosing Malnutrition

P60 The Effectiveness of Nutrition Education: Comparing Registered Dietitian Educators and Dietetic Interns

<h3>Background</h3> The Marshall University Nutrition Education Program (MUNEP) delivers nutrition education to needy elementary schools (grades K-2) in rural West Virginia. This dissertation research reviewed pre-/post-tests and teacher focus group findings comparing effectiveness of RDN educators and dietetic intern (DI) educators in program delivery. DI educators have no formal educational training or pedagogical practice compared to RDNs, yet they play a significant role in program implementation. <h3>Objective</h3> To examine differences in knowledge/behavior change based on pre-/post-scores after an intervention of nutrition education lessons by RDN educators/DI educators; and to compare the effectiveness of RDN educators/DI educators through teacher focus group findings. <h3>Study Design, Setting, Participants</h3> A mixed-methods, retrospective study of (15) knowledge/behavior-change questions on student pre-/post-tests (n = 1160) comparing RDN/DI educators; and results of teacher focus groups (n = 4), with teachers (n = 30) examining the effectiveness of RDN/DI educators in program implementation. <h3>Measurable Outcome/Analysis</h3> Quantitative analysis included independent t-tests comparing pre-/post-test scores for overall knowledge/behavior change; independent t-tests examining post-test scores for overall behavior/overall knowledge and comparing RDN/DI educators; post-hoc Bonferroni ANOVA analysis comparing post-test scores to free/reduced-priced (FR) meals in needy schools. Qualitative inquiry included thematic analysis to compare effectiveness of RDN/DI educators. <h3>Results</h3> Overall knowledge change from pre- to post-test was statistically significant (<i>P</i> = .000); no significant difference in overall behavior change from pre- to post-test (<i>P</i> = .710), or comparison between RDN/DI educators (<i>P</i> = .175 for knowledge change; <i>P</i> = .479 for behavior change) were found. Statistical significance existed for post hoc review of students' post-tests and socio-economic status based on percentage of FR school meals for students in the 50%-59% FR meal category vs students in the 90%-100% FR meal category (<i>P</i> = .017). Focus groups showed that RDN educators were empowered in the classroom and had better management than DI educators; taste-testing is a critical component for both RDN/DI educators. <h3>Conclusions</h3> This study adds to limited data comparing effectiveness of RDN/DI educators in nutrition education. Results will be used to inform DI training, improve MUNEP participant experience related to knowledge and behavior change, and to improve MUNEP experience in needy schools. <h3>Funding</h3> Supplemental Nutrition Assistance Program - Education.

P18 The Use of Guided Reading Questions as a Scaffolding Technique in a Flipped Graduate Metabolism Class

<h3>Objective</h3> Evaluate the use of guided reading questions (GRQ) as a scaffolding technique in a flipped classroom among graduate dietetic interns. <h3>Use of Theory</h3> The Staged Self-Directed Learning Model conceptualizes how students move towards self-directed learning in 4 stages. As students become more responsible for their own learning, they need different guidance or support from the teacher. In a previous study, students were initially resistant to flipped learning. It was hypothesized that if the instructor provided scaffolding techniques, such as GRQ, to help students learn on their own, the resistance to flipped learning may be minimized. <h3>Target Audience</h3> Graduate Dietetic Interns (n = 10) enrolled in a graduate-level metabolism course during their first semester at a midsize, private Midwestern university. <h3>Course/Curriculum Description</h3> In this flipped class, students read textbook chapters and/or watch videos prior to coming to class, then engage in activities (ie, case studies) to apply the information using team-based learning in class. GRQ were provided for students to use when reading the textbook for the first 5 weeks of the semester. <h3>Evaluation Methods</h3> Students completed 8 written learning reflections throughout the semester, which occurred approximately every other week. Content analysis was applied to these reflections to discover themes. <h3>Results</h3> Students viewed the GRQ as instructor support. Students reflected that they appreciated the GRQ at the beginning of the semester, but understood why they would not receive them for the entirety of the course. They reported that the GRQ helped them develop reading comprehension and note-taking skills. At the end of the semester, students reported that they would not need them. <h3>Conclusions</h3> Providing students GRQ in a flipped class, especially at the beginning of the semester, may be a useful scaffolding technique to help students gain skills in learning on their own and reading comprehension.

Evaluation of Dietetic Interns' Research Skills in an Online, Non-Thesis Master's Program

Research is the foundation of dietetics. As programs are designed to meet the 2024 entry-level education requirement, innovative approaches are needed to ensure that master's level registered dietitian nutritionists (RDNs) have strong research skills. The MS Dietetics Program is a new, 14-month, online, non-thesis program completed during the Sodexo Dietetic Internship. The objective was to determine whether an online research curriculum impacted research skills. Students evaluated their skills using a 22-question survey and reported significant improvements from baseline in 8 of the 11 research skills. A future investigation should examine whether increased research involvement among master's level RDNs continues after graduation.

RD Trainees Teaching MD Trainees: Nutrition Assessment Training for Medical Students

Abstract Objectives Less than 25% of medical schools meet US National Academy of Sciences recommendations to provide 25 hours of nutrition education. Medical trainees report dissatisfaction with nutrition training and unpreparedness to counsel patients about nutrition. A pilot program aims to promote medical student understanding of nutrition and increase confidence in future practice. Obstacles to incorporating nutrition content into medical education include financial constraints and determining how to teach and who should teach nutrition, but registered dietitians (RDs) and dietetic interns are in position to advocate for nutrition inclusion in care teams and promote nutrition training in medicine. Methods Nutrition curriculum was developed after surveying nutrition professionals and trainees and incorporated into University of Minnesota medical student site visits to the Minneapolis VA Medical Center. Curriculum included an overview of RD training, the difference between RDs and nutritionists, areas of nutrition specialization, the role of RDs in various care settings, physician attitudes towards ancillary health care professionals affecting patient attitudes, and an overview of nutrition assessments. A diet history and malnutrition assessment nutrition-focused physical exam training were included as interactive activities. Fifty-two students were instructed by a dietetic intern in one of twelve groups of 2–5 during 30–60 minute sessions. Medical students provided feedback on what was learned, what could be applied in future practice, and comments about the training. Results Medical students requested additional nutrition training time and reported awareness of nutrition considerations and RDs in clinical practice, intention to work with RDs, and intention to utilize techniques for diet histories and nutrition-focused physical exams in future assessments. Future work will address program sustainability and efficacy of training videos. Conclusions Registered dietitians and dietetic interns are often in proximity to medical students and could teach nutrition assessments and interdisciplinary collaborations. Providing future physicians the knowledge, skills, and confidence to appropriately incorporate nutrition into practice while collaborating with RDs could positively impact health care and patient care outcomes. Funding Sources N/A

Training Interns in Nutrition and Dietetics: Barriers and Motivators to Being a Preceptor

Abstract Objectives Identify the perceptions and attitudes associated with the preceptor role and incentives that might encourage precepting among nutrition and dietetics professionals in the United States. Methods A random sample of RDN and NDTR professionals from the Commission on Dietetic Registration credentialed practitioner database were invited to complete an online survey about knowledge, attitudes, and perceptions of the preceptor role. The survey was adapted from previous published instruments and validated via external content review, pretesting and post-test evaluation with pilot respondents. Results A total of 311 of 2464 invited eligible participants completed the survey, yielding a response rate of 12.6%. The majority of the sample was white, non-Hispanic with an average age of 44 years. More participants had never served as a preceptor (41%) compared to those that were current preceptors (38%) or former preceptors (21%). Respondents were asked what types of incentives would encourage them to continue to train interns or to consider precepting. The top incentives for all participants were the opportunity to earn continuing education units (65.9%) and having expenses paid to attend a national conference (49.5%). Significantly more (P &amp;lt; .001) former preceptors and those that never precepted reported the ability to choose when to take an intern, training on how to teach and communicate with interns and access to an “on-call” specialist for help or assistance with issues when they arise as incentives compared to current preceptors. Significantly more (P &amp;lt; .01) participants who have never precepted reported training on the internship expectations and the ability to provide input on intern selection process were incentives compared to current or former preceptors. Conclusions Incentives to serve as a preceptor differ based on current, former or never served as a preceptor status. Our results suggest promoting and strategizing solutions to the current imbalance between dietetic internship applicants and qualified preceptors should be targeted based on current, former or never precepted status in order to retain current preceptors, encourage former preceptors to return to precepting and recruit professionals that have never served as preceptors. Funding Sources None

The relationship between interprofessional education experience and perceptions, values, and attitudes towards interprofessional collaboration in dietetics practice

Abstract Interprofessional education (IPE) is associated with improved perceptions, values, and attitudes towards interprofessional (IP) collaboration, and therefore benefits patients, practitioners, and the health care system. However, little is known about how IPE translates into practice once students graduate and begin working in the field. This study examined if previous IPE experience impacts practicing Registered Dietitian Nutritionists' confidence to identify IP competencies, value of IP collaboration, attitudes towards teamwork, IP communication, and role clarity. Data were collected via electronic survey and consisted of questions about demographics, workplace characteristics, the impact of IPE, and IP collaboration concepts. The study sample consisted of graduates of a combined dietetic internship and Master's program, half of which participated in IP team seminars (IPTS) at the university. Means among the group without IPTS experience were higher for confidence to identify IPE competencies, value of IP collaboration, IP communication, and role clarity sections. The group with previous undergraduate IPE had higher means for all IP sections, with significantly higher means in the confidence to identify IPE competencies section (p-value = 0.09). A positive significant relationship was found between a physical space for IP collaboration and positive attitudes towards teamwork (p-value = 0.048). Overall, this study found participation in IPTS did not significantly improve perceptions, values, and attitudes towards IP collaboration among practicing dietitians.

Nutrition and dietetic students’ knowledge and attitudes regarding food science and technology

AbstractThe objective of this study was to assess knowledge and attitudes of nutrition and dietetic college students regarding food science and technology. It was designed as a cross‐sectional survey using a self‐administered online questionnaire, constructed by a formative research process, including accredited dietetics programs in the United States and Puerto Rico. There were a total of 535 participants consisting of adult (≥18 years old) nutrition and dietetic students (undergraduate, graduate, and dietetic interns). Frequencies and percentages were calculated to describe the study participants. Where appropriate, the Chi‐square test was used to test categorical variables across two or more levels. More than half (55.1%) agreed that they were knowledgeable in food science and technology. Greater than half (56.8%) of the participants indicated that they “occasionally” or “rarely” covered food science and technology topics in their current program and 70.1% either “agreed” or “strongly agreed” that their current curriculum could benefit from adding more related topics. Overall, the majority (66.7%) of respondents indicated their overall impression of the food industry was “poor” or “neutral.” The results support adding/strengthening food science and technology components in nutrition curricula. Such education may provide future nutrition professionals with the knowledge and skills needed to effectively utilize food science and technology within their field.

RD Trainees Teaching MD Trainees: Nutrition Assessment Training in Medical Education

Importance of nutrition’s role in health is well established. However, less than one‐quarter of medical schools meet the US National Academy of Sciences recommendation to provide a minimum of 25 hours of nutrition education. Though the clinicians most qualified to provide medical nutrition therapy are registered dietitians (RDs), medical doctors (MDs) are expected to incorporate nutrition into clinical care. An evidence‐practice gap persists as medical trainees report inadequate nutrition education, dissatisfaction with nutrition education, and unpreparedness to counsel patients about nutrition. To provide practical nutrition training to medical students, a dietetic intern at the Minneapolis VA Health Care System developed and taught nutrition curriculum to groups of 2–5 medical students in 30‐minute sessions. Nutrition professionals and trainees were surveyed to assess physician nutrition knowledge deficits observed in clinical practice. The survey guided curriculum development and therefore included an overview of RD training, the difference between RDs and nutritionists, areas of nutrition specialization, the role of RDs in various care settings, physician attitudes towards ancillary health care professionals affecting patient attitudes, and an overview of nutrition assessments. Interactive activities in the training included a diet history practice and discussion and malnutrition assessment nutrition‐focused physical exam training. Medical students provided feedback on what was learned, what could be applied in future practice, and comments about the training. Fifty‐two first‐year medical students from the University of Minnesota each attended one of twelve nutrition assessment trainings at the Minneapolis VA Medical Center between April‐June 2019. Session duration ranged 30–60 minutes based on questions and discussions. Medical student feedback of the training was overwhelmingly positive. Students reported improved awareness of nutrition considerations and RDs in clinical practice, intention to work with RDs, and intention to incorporate strategies and techniques for diet histories and nutrition‐focused physical exams into future assessments. Students were grateful and appreciative of receiving nutrition training from a dietetics trainee and requested more time for comprehensive nutrition training. This program does not yet address the sustainability of nutrition curriculum in medical education, but continuation and expansion of this program will enable further evaluation of efficacy and sustainability. Obstacles to incorporating nutrition content into medical education include financial constraints and determining how to teach and who should teach nutrition. Often in proximity, RD trainees are in position to teach MD trainees nutrition and can promote interdisciplinary professionalism and partnerships. Efforts to provide future physicians the knowledge, skills, and confidence to incorporate nutrition education into practice while simultaneously influencing collaborations with RDs has the potential to positively impact the healthcare system and patient health.Support or Funding InformationSupport was provided by the Minneapolis VA Health Care System Dietetic Internship Program and Geriatric Research, Education, and Clinical Center

Validation of the e-NutLit, an Electronic Tool to Assess Nutrition Literacy

ObjectiveTo validate an electronic nutrition literacy assessment tool (e-NutLit). DesignCross-sectional. SettingAn Australian teaching hospital obesity clinic (clinical cohort) and university (dietetic cohort). ParticipantsA convenience sample of patients with obesity (body mass index > 35 kg m−2) (obese participants [OP]) and dietetic interns (DI). InterventionsThe e-NutLit was administered to OP and scores were compared with performance on the Newest Vital Sign and e-NutLit scores of the DI to establish construct validity. A subset of OP completed the e-NutLit again to examine instrument temporal stability. Internal consistency was assessed using Cronbach α. Main Outcome MeasuresConstruct validity, temporal stability, and internal consistency. AnalysisParametric and nonparametric tests and general linear modeling were used as appropriate. ResultsA total of 103 participants completed the study (OP: n = 59; 64.4% female; DI: n = 44; 86.4% female). Newest Vital Sign and e-NutLit scores were significantly and positively associated (rs = 0.66; P <.001). The DI performed significantly better than the OP (OP: 59.7 ± 13.1 percentage points; DI: 83.9 ± 5.5 percentage points; P <.001), further supporting construct validity. The e-NutLit Cronbach α was >0.9 indicating a good level of internal consistency. The OP test and retest scores were not significantly different, supporting instrument temporal stability. Conclusion and ImplicationsThe results support the validity of the e-NutLit, for both clinicians and researchers.

Research Involvement Continuum Level of Dietetic Internship Directors

Research is considered to be the foundation of the profession of dietetics, and it is a required component of the dietetic internship (DI) curriculum. However, studies have shown that dietitians, including dietetic educators, are not highly involved with research. This research-competency gap has been studied in the literature, but the role of DI directors, who are the gatekeepers of DI programs, have not been included in empirical discussions on this topic. The purpose of this study was to identify where DI directors fall on the research involvement continuum as defined by the Research Involvement Questionnaire (RIQ) and to identify the types of factors that influence DI directors’ involvement with research. In this cross-sectional survey study that included 96 DI directors, research involvement of DI directors was limited. Using the four levels of the research involvement continuum, it was found that more participants were classified into level one (low research experience) than levels two through four combined. Research involvement was most related to education/training, professional experience, and research experience. Based upon the theory of experiential learning, dietetic educators must have meaningful experiences with research in order to reach the higher levels on the research continuum. The findings from this study can be used to better prepare DI directors and other dietetic educators as well as to inform curricular decisions to better align education and practice within the profession of dietetics.