Dietetic Programs Research Articles

Awareness and Use of Holistic Admissions Practices Among Directors of Accredited Dietetics Programs

Awareness and Use of Holistic Admissions Practices Among Directors of Accredited Dietetics Programs

Sustainable food systems education in nutrition and dietetics: an appraisal of the tertiary landscape in multiple countries

Purpose Despite a growing awareness of the gap between professional expectations and competence, there has been no comprehensive appraisal of sustainable food systems (SFS) education within dietetics and nutrition programs to date. Dietitians and nutritionists play important roles in promoting sustainability yet many perceive themselves to be inadequately trained. The purpose of this study was to explore how, and to what degree, SFS education is incorporated into accredited nutrition and dietetics programs in the United Kingdom, Australia and Canada. Design/methodology/approach A content analysis of course descriptions from program websites was conducted between 2021 and 2022. Courses were reviewed, analyzed and evaluated using a novel sustainability metric. Findings SFS is integrated into the education environment of some, but not all, dietetics and nutrition programs to varying degrees (no, partial and full). Partial and full integration was present in a small percentage of courses, with a larger percentage in nutrition programs. SFS education was offered more often through a single unit than a dedicated course. Twelve best practice examples of courses dedicated to SFS were identified. In the UK, their focus was nutrition and diet, contrasting food and food systems in Australia and Canada. Originality/value These findings provide insight into SFS education for professional societies, instructors and program directors. Through intentional curricular design considerations supported by this study, program leads can take small conscious reorganizational steps to integrate SFS. This study offers a sound methodology to initiate and benchmark further assessment and a novel approach for other professions looking to equip their future workforce through SFS education.

Investigation of Communication Skills and Subjective Well-being Levels in Helping Professional Groups

This study examines the relationship between communication skills and subjective well-being among students in the psychological counseling and guidance and nutrition and dietetics programs. The research, which involved 430 university students as professional candidates, investigates the impact of program, gender, grade, perceived parental behaviours, and residence on both subjective well-being and communication style. The results indicate a significant association between effective communication, well-being, and family influences, highlighting their crucial role in personal and professional development. It is worth noting that gender differences in subjective well-being and communication skills levels were identified, with females exhibiting higher scores. These findings have important implications for the design of psycho-education programs and support measures. The study provides guidance for tailoring interventions to address gender-specific needs and recognizes the influential role of familial factors in cultivating communication and well-being competencies of students in counseling and nutrition-related disciplines.

Didactic program in dietetics (DPD) students’ experiences with pandemic learning and expectations for their future education: a descriptive study through a systems lens

BackgroundThe systems approach has been used to evaluate higher education and explores inputs, transformation process, and outputs of a system that is also influenced by environmental factors such as COVID-19. The COVID-19 pandemic shifted many college students to different learning modes, changing their university experience. This study evaluated dietetics students’ education experiences and characteristics in the latter period (spring 2022) of the COVID-19 pandemic using the systems approach.MethodsResearchers developed and distributed an electronic survey to all 215 US-based Didactic Program in Dietetics (DPD) directors during March to May 2022 to forward to their students. Researchers calculated descriptive statistics for variables related to inputs, transformation process, and outputs in the systems approach.ResultsRespondents (n = 341) represented 51 DPDs in 31 states in the United States. Overall, DPD students (88.5%) were mostly or very satisfied with their choice of majoring in dietetics. Most (84.0%) planned to earn the RDN credential. Nearly half (46.9%) of DPD students were somewhat or extremely concerned about their readiness to continue their dietetics education path due to the pandemic-related learning conditions. Most students (43.6%) reported dissatisfaction with asynchronous remote instruction in laboratory courses. DPD students’ GPAs remained consistent within the range of 3.75-4.0 from Fall 2019 (43.2%) to Spring 2022 (44.5%). The most important expectations of professors moving forward were to communicate effectively (97.3%), employ cultural humility (93.8%), eliminate discrimination in the classroom (93.6%), provide lecture slides (89.7%), and be flexible and accommodating (88.7%).ConclusionsDPD students emerged from COVID-19 with new perspectives and expectations for their university learning experience. Future research should explore the perspectives of DI directors, preceptors, and employers of COVID-19 era DPD graduates.

A Nationwide Survey of Clinical Dietitians' Perceptions of Precepting

Clinical preceptor shortages are a limiting factor for programs in dietetics. Perceptions on precepting were obtained from 378 registered dietitian nutritionists. The top benefits of precepting included improved teaching skills, staying current/stimulated in the profession, and increased awareness of practice area. Frequently reported barriers included inadequate compensation, time, and reward. People who had not precepted in the past year indicated higher perceived benefits of precepting. Those who indicated they would discontinue precepting reported significantly fewer benefits and more barriers than those who would continue. Finding and addressing barriers among a program's preceptor pool may be key to promoting preceptorship.

Use of an Escape Room to Enhance Nutrition Care Process Skills and Self-efficacy

Application of the Nutrition Care Process (NCP) is a fundamental concept for students preparing to become registered dietitian nutritionists (RDNs). Adequate practice, within pedagogical methods designed to mimic actual dietetics practice scenarios as realistically as possible, is necessary to increase student NCP skill proficiency and confidence. This study assessed the impact of a virtual escape room experience compared with a traditional case study on both NCP skills and confidence in a senior didactic program in dietetics for undergraduate students. Results indicate that the escape room experience improved both NCP documentation (P < .001) and student self-efficacy (P < .001).

Evidence-Based Practice Competencies among Nutrition Professionals and Students: A Systematic Review

BackgroundEvidence-based practice (EBP) promotes shared decision-making between clinicians and patients. ObjectiveThe aim was to determine EBP competencies among nutrition professionals and students reported in the literature. MethodsWe conducted a systematic review by searching Medline, Embase, CINAHL, ERIC, CENTRAL, ProQuest Dissertations and Theses Global, BIOSIS Citation Index, and clinicaltrials.gov up to March 2023. Eligible primary studies had to assess one of the 6 predefined EBP competencies: formulating clinical questions; searching literature for best evidence; assessing studies for methodological quality; effect size; certainty of evidence for effects; and determining the applicability of study results considering patient values and preferences. Two reviewers independently screened articles and extracted data, and results were summarized for each EBP competency. ResultsWe identified 12 eligible cross-sectional survey studies, comprising 1065 participants, primarily registered dietitians, across 6 countries, with the majority assessed in the United States (n = 470). The reporting quality of the survey studies was poor overall, with 43% of items not reported. Only 1 study (8%) explicitly used an objective questionnaire to assess EBP competencies. In general, the 6 competencies were incompletely defined or reported (e.g., it was unclear what applicability and critical appraisal referred to and what study designs were appraised by the participants). Two core competencies, interpreting effect size and certainty of evidence for effects, were not assessed. ConclusionsThe overall quality of study reports was poor, and the questionnaires were predominantly self-perceived, as opposed to objective assessments. No studies reported on competencies in interpreting effect size or certainty of evidence, competencies essential for optimizing clinical nutrition decision-making. Future surveys should objectively assess core EBP competencies using sensible, specific questionnaires. Furthermore, EBP competencies need to be standardized across dietetic programs to minimize heterogeneity in the training, understanding, evaluation, and application among dietetics practitioners.This study was registered at PROSPERO as CRD42022311916.

Serum levels of Vanin-2 increase with obesity in relation to inflammation of adipose tissue and may be a predictor of bariatric surgery outcomes.

Excessive obesity can lead to dysfunction in adipose tissue, which contributes to the development of comorbidities associated with obesity, such as type 2 diabetes (T2D), cardiovascular and cerebrovascular disease, among others. Previous research has mainly focused on the Vanin family in systemic inflammatory diseases or predicting its role in tumor prognosis, while neglecting its role as a secretory protein in adipose tissue inflammation and metabolism. The objective of this study was to compare the changes in Vanin-2 levels in the circulating blood of normal and obese individuals, and to assess its correlation with inflammatory factors in vivo. Furthermore, the study aimed to systematically evaluate its effectiveness in human weight loss surgery. Serum concentrations of Vanin-2 and inflammatory indicators were measured in 518 volunteers. Furthermore, the concentrations of Vanin-2 were measured both before and after weight loss through a dietetic program or laparoscopic sleeve gastrectomy (LSG). Additionally, we assessed the levels of insulin, adiponectin, and inflammation-related factors. The hormonal profile and changes in body weight were evaluated at baseline and 3 months after surgery. Serum levels of Vanin-2 were found to be significantly increased in individuals with overweight/obesity (OW/OB) group (controls 438.98 ± 72.44, OW/OB 530.89 ± 79.39 ug/L; p < 0.001). These increased levels were associated with IL-18, BMI, FAT%, and HOMA-IR. However, levels of Vanin-2 remained unchanged after conventional dietary treatment. On the other hand, weight loss induced by LSG resulted in a significant decrease in Vanin-2 concentrations from 586.44 ± 48.84 to 477.67 ± 30.27 ug/L (p < 0.001), and this decrease was associated with the Vanin-2 concentrations observed before the operation. Serum Vanin-2 is a highly effective biomarker for assessing adipose tissue inflammation in obesity and has the potential to serve as a predictor of bariatric surgery outcomes.

Building a resilient future workforce: Analysis of initiatives in Australian and New Zealand dietetics curricula.

Dietitians work in high-pressure environments and student dietitians attend placement in these settings. Resilience is a personal quality that can buffer against the stressors of professional placement; however, little is known about how dietetics students learn resilience. This study aimed to describe how resilience is embedded within Australian and New Zealand dietetics curricula. This three-phased qualitative study examined 18 credentialed dietetics education programs in Australia (n = 16) and New Zealand (n = 2). In Phase 1 (document analysis), publicly available curricular documents were screened for key resilience terms. In Phase 2, academics were invited to participate in a semi-structured interview on Microsoft Teams to verify and advance upon documentary evidence. Extracted data were combined and evaluated according to Bloom's Taxonomy in Phase 3. Fifty-six courses were found to have documented mentions of resilience factors from dietetics programs in Australia and New Zealand. Academics from 14 universities (12 Australia and 2 New Zealand) were interviewed. Three themes were identified from Phase 3: Resilience is valuable content within a dietetics degree, Resilience can be taught indirectly throughout programs and Resilience education is not static. Resilience education was mostly taught by academic dietitians in courses prior to placement and assessed by students completing self-reflection while on placement. The documentation of resilience within learning objectives and graduate attributes varied between universities. While all dietetics programs included some resilience curricula, academics acknowledged that resilience content and their own knowledge base could be strengthened. The findings provide direction for program improvements and further research.

Dietetics Workforce Diversification Includes Disability Accessibility and Websites of the Academy, CDR, and Dietetic Programs Need to Adhere to “Web Content Accessibility Guidelines”

Dietetics Workforce Diversification Includes Disability Accessibility and Websites of the Academy, CDR, and Dietetic Programs Need to Adhere to “Web Content Accessibility Guidelines”

Impact on diabetes outcomes and team skills of integrating dietetic services into interprofessional education and teamwork in primary care.

Diabetes is a complex disease requiring daily self-management of diet and activity, yet many patients do not receive recommended self-management education, medical nutrition therapy, or team-based care that includes registered dietitian nutritionists (RDNs). Such service deficits contribute to challenges in meeting combined diabetes care goals. We evaluated the impact of adding RDN-supervised dietetic interns to an established primary care interprofessional education/teamwork model on patients' clinical outcomes and health professions students' team skills. Electronic health records were retrospectively analyzed to evaluate the impact of interprofessional care teams including dietetic practitioners on patient outcomes and compare these changes to outcomes achieved with the previous model without such participation. Pre-test/post-test surveys were used to evaluate health professions students' self-reported changes in team skills. Patient outcomes for glycemic control, systolic blood pressure, triglycerides, and depression improved significantly, and emergency department visits decreased by 79% after interprofessional care. Average hemoglobin A1c levels decreased from 11.6% to 8.3% (p < .001), an additional 1.1% reduction over previous results, following incorporation of dietetic practitioners. Students reported increased team skills after interprofessional care participation. Health professions and dietetic program faculty should collaborate to develop interprofessional best practice primary care models for patients with diabetes.

Editorial introductions.

Editorial introductions.

Preparing Registered Dietitian Nutritionists for Leadership in Culinary Medicine: Opportunities, Barriers, and Alternatives in Registered Dietitian Nutritionist Education and Training.

The field of Culinary Medicine (CM) has gained significant traction in recent years through initiatives within and beyond the clinical setting. Leveraging their skills in nutrition education, nutrition research, and medical nutrition therapy, many registered dietitian nutritionists (RDNs) have found ways to contribute to CM initiatives despite the absence of consistent, formalized CM training requirements for RDNs. The Accreditation Council for Education in Nutrition and Dietetics defines 31 core knowledge and 50 core competency standards for the Didactic Program in Dietetics and Dietetic Internship, respectively. CM is not required in any of these 81 identified standards, and only a few programs have voluntarily incorporated CM competencies into their co-and extracurricular offerings. This commentary provides support for further research to quantify the degree of inclusion of CM training in the current education pathway for RDNs. The ever-changing landscape of the field of nutrition necessitates ingenuity and evolution in education to best prepare the next generation of RDN practitioners. Highlighting the applications of CM across disciplines and recognizing the creative ways RDNs have found to gain experience and expertise in CM beyond their requisite education, this commentary seeks to emphasize the need for and capacity of RDNs to contribute as leaders in CM.

Exploring the eating disorder curricula of accredited university dietetic programs in Australia and New Zealand

BackgroundDietitians are viewed as integral members of the multidisciplinary treatment team for people with eating disorders (EDs). However, low levels of perceived confidence, competence, and willingness to practice in this clinical area, have been reported by dietitians and student dietitians. As the extent of ED-specific knowledge and skills-based training within tertiary accredited dietetic programs is currently unknown, this research aimed to: (1) obtain insights into the current ED-specific knowledge base and training content of dietetic curricula in both Australian and New Zealand universities; (2) understand the perspectives of course convenors regarding the role of dietitians in ED treatment and their employment opportunities; and (3) identify gaps and opportunities for improving university programs and the dietetic workforce.MethodsCourse convenors (or their nominated representative) of Australian and New Zealand accredited dietetic programs were invited to participate in a semi-structured virtual interview. A purpose-built question guide was developed to explore the inclusion and/or integration of ED-specific content into the curricula, and the perspectives of course convenors toward the role of dietitians in the treatment of EDs, and their employment opportunities. The interviews were audio recorded, transcribed verbatim, and analysed qualitatively using inductive thematic analysis.ResultsThirteen participants who represented 14 universities and 19 individual accredited dietetic programs, were interviewed, with some participants representing more than one university. Three dominant themes emerged: (1) varying ED-specific content and training in dietetic programs; (2) unclear dietitian's role in the treatment of EDs, and (3) contrasting views regarding ED clinical practice and employment.ConclusionsED-specific content was embedded within all the dietetic programs investigated in this study. However, this content was generally limited to an introductory level, with notable variations found between the depth of content and the type of training provided. Risk-mitigation skill development, such as screening for EDs, and early identification of symptoms, also varied between programs. Therefore, it is recommended that ED-specific skill development and knowledge is enhanced within Australian and New Zealand university programs, to support effective, safe, and timely care for people with EDs. This research has implications for current and future university dietetic program development and the broader dietetic workforce.

Current Dietetic Internship Admission Criteria and Selection Processes: Results From an Electronic Survey of Directors.

Members of the dietetics profession have been discussing and confronting the lack of diversity within the profession. The Academy of Nutrition and Dietetics is committed to diversity and inclusion efforts. Our aim was to determine current admission criteria and practices used by Dietetic Internships (DIs) across the United States. This was a cross-sectional study using electronic survey with open and close-ended items conducted in the fall of2020. The electronic survey was distributed to 261 DI directors. Statistical analysis performed Descriptive statistics were calculated for each variable using SPSS software. Six topically related open-ended items were analyzed through a qualitative thematic approach. DI directors (n= 89) were primarily female (n= 76) and White (n= 77). Most admissions process and criteria decisions were made by committees. Directors (n= 79) reported using a predefined rubric/scoring system for candidate evaluation. Many (n= 60) indicated not using Graduate Record Examination scores. All reported considering Didactic Program in Dietetics' grade point average; personal statement quality; professional interests and goals; and type and quantity of previous dietetics-related work and volunteer experience. The admission factors rated (on a 7-point scale) most important were quality of interview (mean= 6.03), Didactic Program in Dietetics' grade point average (mean= 5.67), type of work and volunteer experience (mean= 5.62), quality of personal statement (mean= 5.5), recommender comments (mean= 5.41), and quantity of work and volunteer experience (mean= 5.40). Most (n= 80) indicated that they were satisfied with their selection processes. Educators should continue refining admissions processes as professional gatekeepers, consider reducing application fees, diversifying and training selection committees, re-evaluating admission criteria, and assessing how criteria weights.

Development and Evaluation of an Online Simulated Hospital Unit for Nutrition Assessment Training

Students in a didactic program in dietetics (n = 147) and dietetic interns (n = 50) engaged with a web-based clinical simulation to practice the nutrition care process. An evaluation survey with open and closed-ended questions was used to collect data from participants. Survey results indicated that a majority of participants felt the simulation was easy to engage with, was valuable to their education, and facilitated their understanding of conducting nutrition assessments. Qualitative analysis of open-ended questions produced themes in participants' responses to their experience with the simulation. A web-based clinical simulation can be valuable in dietetics education and effectively support learning.

An Exploratory Mixed Method Cross-Sectional Study to Identify Opportunities to Increase Enrollment and Retention of Native Hawaiian Students in an Undergraduate Dietetic Program.

Native Hawaiians (NH) are underrepresented in dietetics, contributing to less than 1% of the profession nationally. Increasing the number of NH Registered Dietitian Nutritionists (RDN) is one mechanism to facilitate improved health outcomes in disparate populations. 1) Identify and summarize NH student interests in the field of nutrition and dietetics; 2) Identify and contextualize factors that support and prohibit achievement of academic goals and aspirations; 3) Identify NH students' responsibility to the community; 4) Explore the context around NH alumni enrollment in nutrition and dietetics and their perceived impact of RDNs in the community; 5) Identify and describe supporting agencies that foster academic and professional success. This exploratory mixed-methods cross-sectional study surveyed all levels of NH nutrition and dietetics students in the University of Hawai'i (UH) System. In addition, in-depth interviews were conducted with NH students, NH alumni, and supporting agencies to identify supports and barriers, explore the context of NH enrollment in nutrition and dietetics, and the contribution of dietetics to the NH community. Eighty-one NH students enrolled in a nutrition course across the UH system were surveyed. Nine of the 81 NH students surveyed, eight NH alumni, and persons from 15 identified supporting agencies were interviewed. Survey responses were descriptively analyzed. Open-ended survey questions and interviews were analyzed through content analysis. To ensure findings were guided by NH perspective, data were triangulated by researchers and a NH dietetics advisory council. Food and chronic disease prevention and management were topics that drew NH students to the field. Bridge/scholarship programs supported NH academic achievement. Education-related cost was a perceived barrier. Alumni and students shared varying degrees of responsibility to serve the NH community. Increasing the connection between NH values and the nutrition and dietetics curriculum are an identified need. Findings illuminate opportunities to drive future programmatic efforts. The framework used in this study should be adaptable to other programs to support overall dietetics diversity initiatives.

Shifting the narrative and practice of assessing professionalism in dietetics education: An Australasian qualitative study.

We aimed to explore current approaches to assessing professionalism in dietetics education in Australia and New Zealand, and asked the questions what is working well and what needs to improve? We employed a qualitative interpretive approach and conducted interviews with academic and practitioner (workplace-based) educators (total sample n=78) with a key stake in dietetics education across Australia and New Zealand. Data were analysed using team-based, framework analysis. Our findings suggest significant shifts in dietetics education in the area of professionalism assessment. Professionalism assessment is embedded in formal curricula of dietetics programs and is occurring in university and placement settings. In particular, advances have been demonstrated in those programs assessing professionalism as part of the programmatic assessment. Progress has been enabled by philosophical and curricula shifts; clearer articulation and shared understandings of professionalism standards; enhanced learner agency and reduced power distance; early identification and intervention of professionalism lapses; and increased confidence and capabilities of educators. These findings suggest there have been considerable advances in professionalism assessment in recent years with shifts in practice in approaching professionalism through a more interpretivist lens, holistically and more student-centred. Professionalism assessment in dietetics education is a shared responsibility and requires further development and transformation to more fully embed and strengthen curricula approaches across programs. Further work should investigate strategies to build safer learning cultures and capacity for professionalism conversations and in strengthening approaches to remediation.

“In China, I live to eat. Here, I eat to live”

The population of international students in Canadian post-secondary institutions, including in dietetic programs, is growing. In addition to academic stress, international students must cope with culture change and acculturative stress, which has been found to increase the prevalence of problematic eating and body image concerns among this population. Research indicates that problematic eating and body image concerns may also be relatively high among dietetic students due, in part, to the emphasis on body weight management and the narrow representations of healthy eating, and the disciplinary processes of professional socialization that are characteristic of dietetic education. For international dietetic students, vulnerability to problematic eating and body image concerns may be particularly acute, given their position as both dietetic and international students. However, little is known about the experiences of this population, and if, how and to what extent being an international dietetic student may impact on eating and body image concerns, or what efforts may be needed to prevent and support those experiencing these concerns. This research used the EAT-26 questionnaire and one-on- one, semi-structured interviews to explore how culture change impacts eating and body image among Mandarin-speaking, Chinese international dietetic students. Results indicate that culture change has a significant impact on the relationships to food and on eating and body image among the study population. Further research is needed to elucidate the impacts of culture change, and how dietetic educators may best support international dietetic students.

Evaluation of a Media Training Workshop for Nutrition Students and Trainees in Nova Scotia.

Gaps in communication training have been identified in Canadian and international academic and practicum dietetics programs. A workshop was developed to pilot supplementary media training to nutrition students/trainees studying in Nova Scotia. Students, interns, and faculty from two universities participated in the workshop. Data on perceived learning, media knowledge/skill use, and workshop feedback were collected immediately post-workshop using a mixed-form questionnaire. A modified questionnaire was administered eight months post-workshop to obtain information on utility of the perceived acquired knowledge/skills. Closed-ended responses underwent descriptive analysis, while open-ended responses underwent thematic analysis. Twenty-eight participants completed the questionnaire post-workshop, and six completed it at follow-up. All participants rated the workshop positively (7-point Likert scale) and reported learning something new (perceived). Perceived learning emphasized general media knowledge/skills and communication skills. Follow-up data suggested participants had applied perceived media knowledge/skills in message development and media and job interviews. These data suggest that nutrition students/trainees may benefit from supplementary communications and media training and provide a stimulus for ongoing curriculum review and discussion.