Teaching and assessment of communication skills in dietetics: a scoping review.

BACKGROUND: Communication is a core element of dietetic practice, and although communication skills are a prominent feature of dietetic curricula, research suggests a need for more consistent approaches. The evidence on how communication skills are taught and assessed in dietetics has not been synthesised leaving uncertainty about best practice. This scoping review aimed to examine and map the research literature relating to the teaching and assessment of communication skills in dietetics. METHODS: The review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. Five electronic databases, two theses databases and eight conference proceedings were systematically searched for research on how communication skills are taught and assessed in dietetics. The search had no geographical or time limits. Studies were independently screened by two authors, summarised thematically using the Kirkpatrick Model and narratively synthesised. RESULTS: The 45 included studies were organised thematically into three categories: (i) the inclusion of communication skills education in dietetics, suggesting that dietitians have variable experiences; (ii) approaches to teaching communication skills in dietetics, characterised predominantly by a move away from didactic approaches in favour of experiential opportunities for learning such as simulation; and (iii) assessment of communication skills in dietetics, including the use of both dietetic-specific and generic tools. CONCLUSIONS: The included studies demonstrate that although a variety of teaching strategies are used in the development of communication skills in dietetics, there is potential for more robust evaluation and more diverse approaches to support dietetic educators to prepare the dietetic workforce.

Self-completed online dietary recalls as an alternative method of dietary assessment for dietetic outpatient appointments: A feasibility study.

BACKGROUND: Integrating digital dietary assessment within dietetic care could save time and reduce costs, at the same time as increasing patient engagement. The present study explores the feasibility of implementing a web-based dietary assessment tool, myfood24 (https://www.myfood24.org), into routine healthcare. METHODS: This mixed methods feasibility study recruited dietitians and patients from a National Health Service (NHS) hospital outpatient setting. Patients completed and shared three online 24-h dietary recalls in advance, which were used as a dietary assessment by dietitians. Recruitment data were collected and questionnaires on technology, usability, and acceptability were completed. Patient interviews and focus groups with dietitians were conducted. RESULTS: Eleven dietitians working in allergy, bariatrics, diabetes, oncology, general, renal, infectious diseases, and coeliac services took part with 39 patients. Recruitment rates were highest in bariatrics and lowest in renal and oncology. Compared to other studies, completion rates were good, with 29 (74.4%) completing three recalls despite lower technology readiness and software usability scores than in similar studies. Illness and difficulty with technology were reasons for non-completion. Opportunity to receive nutritional feedback from the tool and share this with a dietitian motivated patients to complete the record accurately. Consultation times were shortened in approximately one-third of appointments and a higher proportion of time was spent on nutritional education compared to usual practice. However, mean preparation time increased by 13 min per appointment because dietitians found nutritional analysis reports difficult to interpret. CONCLUSIONS: It is feasible to introduce a digital dietary assessment tool into NHS dietetic practice. However, further development is needed to ensure that the tool is suitable for healthcare.

Content Analysis of Websites of Didactic Programs in Dietetics for Evidence of Diversity, Equity, and Inclusion.

OBJECTIVE: To examine websites of didactic programs in dietetics (DPD) for diversity, equity, and inclusion (DEI)-related language and to assess perceived gender and ethnic/racial representation in images. METHODS: We conducted a content analysis on the first 6 website images and 3-elements of DPD (n = 212) websites (mission statement, goals and objectives, and the immediate landing page). Descriptive statistics and a website DEI score were calculated. RESULTS: Equity and inclusion-related terms appeared on < 5% of websites. Diversity and culture-related terms appeared on about one-third of websites. On average, researchers perceived 28.45% of people in website images as non-White, and 20.11% as non-female. Most websites received low DEI scores. CONCLUSIONS AND IMPLICATIONS: The DPD websites had a limited representation of DEI-related terms and image representation of individuals perceived to be non-female and non-White. Leaders of DPDs may consider displaying and describing the program's commitment to DEI on the website for potential students.

Moving Dietetics Forward with Queer Pedagogy: A Post-Structural Qualitative Study Exploring the Education and Training Experiences of Canadian Dietitians for LGBTQ Care.

BACKGROUND: Lesbian, gay, bisexual, trans, and other sexually and gender diverse (LGBTQ) people often experience health disparities and disparities in accessing safe health care. Yet dietetics curriculum and training opportunities for LGBTQ care are limited. OBJECTIVE: The objective of this research was to explore the perspectives and professional training experiences within LGBTQ-focused topics of Canadian dietitians in order to inform future curriculum and pedagogy. DESIGN: This research is framed within poststructuralist philosophies. Semi-structured qualitative interviews were conducted. PARTICIPANTS/SETTING: To be eligible, participants needed to be dietitians within Canada who had an interest in discussing gender and sexual diversity within the profession. Although the research call was open to all Canadian dietitians who wanted to discuss gender and sexual diversity within the profession, only dietitians who self-identified as allies to LGBTQ groups ended up participating in this project. Of the 16 dietitians who participated, 11 participants self-identified as members of LGBTQ groups and 5 self-identified as straight. All participants took part in online interviews done in private locations of their choosing from September 2020 to January 2021. ANALYSIS: A systematic thematic analysis was conducted. RESULTS: Three themes, including understanding the ethics of dietetics education, recognizing the cis- and hetero-normativity of dietetics education, and moving forward with queer pedagogy, were noted from the data. CONCLUSIONS: Participants explored the lack of LGBTQ focus and content during their professional training and believed such gaps were problematic to the caring philosophies of dietetics. Participants offered insights into how dietetics educators can disrupt ingrained cis- hetero-normativity and rigid binary gender norms within dietetics education and curriculum.

The Value of Programmatic Assessment in Supporting Educators and Students to Succeed: A Qualitative Evaluation.

BACKGROUND: Programmatic assessment has been proposed as the way forward for competency-based assessment, yet there is a dearth of literature describing the implementation and evaluation of programmatic assessment approaches. OBJECTIVE: To evaluate the implementation of a programmatic assessment and explore its ability to support students and assessors. DESIGN: A qualitative evaluation of programmatic assessment was employed. PARTICIPANTS/SETTING: Interviews with graduates (n = 8) and preceptors (n = 12) together with focus groups with faculty assessors (n = 9) from the one Australian university explored experiences of the programmatic approach, role of assessment in learning, and defensibility of assessment decisions in determining competence. ANALYSIS PERFORMED: Data were analyzed into key themes using framework analysis. RESULTS: The programmatic assessment increased confidence in defensibility of assessment decisions, reduced emotional burden of assessment, increased value of assessment, and identified and remediated at-risk students earlier when philosophical and practice shifts in approaches to assessment were embraced. CONCLUSIONS: Programmatic assessment supports a holistic approach to competency development and assessment and has multiple benefits for learners and assessors.

Integration of an Image-Based Dietary Assessment Paradigm into Dietetic Training Improves Food Portion Estimates by Future Dietitians.

The use of image-based dietary assessments (IBDAs) has rapidly increased; however, there is no formalized training program to enhance the digital viewing skills of dieticians. An IBDA was integrated into a nutritional practicum course in the School of Nutrition and Health Sciences, Taipei Medical University Taiwan. An online IBDA platform was created as an off-campus remedial teaching tool to reinforce the conceptualization of food portion sizes. Dietetic students' receptiveness and response to the IBDA, and their performance in food identification and quantification, were compared between the IBDA and real food visual estimations (RFVEs). No differences were found between the IBDA and RFVE in terms of food identification (67% vs. 71%) or quantification (±10% of estimated calories: 23% vs. 24%). A Spearman correlation analysis showed a moderate to high correlation for calorie estimates between the IBDA and RFVE (r ≥ 0.33~0.75, all p < 0.0001). Repeated IBDA training significantly improved students' image-viewing skills [food identification: first semester: 67%; pretest: 77%; second semester: 84%) and quantification [±10%: first semester: 23%; pretest: 28%; second semester: 32%; and ±20%: first semester: 38%; pretest: 48%; second semester: 59%] and reduced absolute estimated errors from 27% (first semester) to 16% (second semester). Training also greatly improved the identification of omitted foods (e.g., condiments, sugar, cooking oil, and batter coatings) and the accuracy of food portion size estimates. The integration of an IBDA into dietetic courses has the potential to help students develop knowledge and skills related to "e-dietetics".

Relationship of Emotional Intelligence to Perceived Stress in Combined Master's of Science and Dietetic Internship Programs.

BACKGROUND: Emotional intelligence (EI) is often studied with perceived stress in students in health professions fields such as nursing but not dietetics. The purpose of this study was to explore the relationship of EI to perceived stress in graduate dietetic students in Combined Master's of Science (MS) and Dietetic Internship (DI) programs. METHODS: EI and perceived stress were collected using the Schutte EI Scale and Perceived Stress Scale-10, respectively. One hundred and two (n=102) graduate dietetic students were recruited through their program directors. All participants had to be enrolled in, and have completed at least one semester, in an Accreditation Council for Education in Nutrition and Dietetics (ACEND)-accredited combined MS/DI program. RESULTS: Graduate dietetic students with higher EI are more likely to have lower perceived stress (r= -0.305, p=0.002). Females had significantly higher perceived stress scores than males (p=0.011). EI scores between female and males was found to be not significant (p=0.082). Perceived stress was significantly associated with class size (r=0.223, p=0.025). CONCLUSIONS: The findings suggest that graduate dietetic students with higher EI scores have lower self-perceived stress. Increasing EI skills in graduate dietetic students might help reduce stress levels and create better coping skills.

Cultural Competency Training and Evaluation Methods Across Dietetics Education: A Narrative Review.

Developing cultural competence among credentialed nutrition and dietetics practitioners is critical to move toward eliminating disparities in health care. Despite emphasis put forth on culturally competent care by credentialed nutrition and dietetics practitioners, the types, methods, and outcomes of cultural competency training are lacking or inconsistent. In this narrative review, we evaluated studies detailing cultural competency training for content, modes of delivery, and learner outcomes. Main inclusion criteria were students in dietetics or credentialed nutrition and dietetics practitioners engaging in an educational intervention. Exclusion criteria were studies published before 2000 and not published in the English language. Ten studies were reviewed from four health science databases. Our aims were to quantify the literature on cultural competence training in dietetics education and describe the interventions to identify gaps within the field; thus, a quality assessment tool was not utilized. Data were extracted on learner type, number of participants, curriculum content, intervention type, learning outcomes, and outcome evaluation tool. Most studies employed interprofessional education (n=7) and/or service learning (n=6) as interventions types. Quantitative evaluation of learners in the studies reviewed indicated increased knowledge and skill (statistically significant; n=2), whereas qualitative evaluation of learners indicated themes, including curriculum satisfaction, gains in competence, and comfort working with diverse people. Methods of evaluation and delivery were inconsistent, making it difficult to draw larger conclusions about cultural competency training in dietetics. Cultural competence creates opportunities for growth and development of health professionals to serve diverse communities and work environments; future work should include standardizing evaluations of training, specifically to include both qualitative and quantitative methods.

Social Justice and Dietetic Education: Are We Preparing Practitioners to Lead?

Purpose: To explore dietetic practitioners' perceptions of their education and training in the knowledge, skills, and confidence to understand social justice issues and to engage in socially just dietetic practice and social justice advocacy. Methods: An online semi-qualitative survey sent to Canadian dietitians. Results: Most respondents (n = 264; 81.5%) felt that knowledge- and skill-based learning about social justice and social justice advocacy should be a part of dietetic education and training. Reasons given by respondents for the importance of social justice learning include: client-centred care and reflexive practice, effecting change to the social and structural determinants of health, preventing dietitian burnout, and relevance of the profession. Yet, over half of respondents either strongly disagreed or disagreed that they were adequately prepared with the knowledge (n = 186; 57.4%), skills (n = 195; 60.2%), or confidence (n = 196; 60.5%) to engage in advocacy related to social justice concerns. Some questioned the practicality of adding social justice learning via additional courses to already full programs, while others proposed infusing a social justice lens across dietetic education and practice areas. Conclusions: Dietetic education and training must do more to prepare dietitians to answer calls for dietitians to engage in social justice issues through practice and advocacy.

Assessment of Specifications Grading in an Undergraduate Dietetics Course.

Assessing student learning is an integral component of teaching undergraduate dietetics students. Traditional grading can be cumbersome for instructors, encouraging extrinsic motivation for students and hindering clear understanding of whether students have met course learning outcomes. Specifications grading is a reimagined assessment paradigm that empowers both students and instructors to focus on achievement of learning objectives. This report examines the deployment of specifications grading in an undergraduate dietetics course, using qualitative methods to determine the impact on students' learning and experiences. Employing specifications grading may help dietetics educators foster self-regulation and mastery learning for students, as well as increase grading transparency.

Nutrition assessment in process-driven, personalized dietetic intervention - The potential importance of assessing behavioural components to improve behavioural change: Results of the EU-funded IMPECD project.

BACKGROUND & AIMS: Although up-to-date definitions for nutrition assessment integrate behavioural components, it is not clear what behavioural components are to be assessed. Since behavioural modification is linked to effective therapeutic dietetic interventions, assessing behaviour and factors influencing behaviour might be beneficial to improve personalized dietetic outcome. The aim of the following report is to emphasize the role of behavioural components and factors affecting behaviour at baseline nutrition assessment in personalized dietetic intervention. METHODS: The present work is part of the EU-funded project IMPECD ("Improvement of Education and Competences in Dietetics", www.impecd.eu). The project aims to improve the clarity and consistency of national dietetic process models to unify education and training of future dietitians. Experts from five European Universities of Applied Sciences (UAS) in Antwerp (BE), Fulda (DE), Groningen (NL), Neubrandenburg (DE) and St. Pölten (AT) developed a Massive Open Online Course (MOOC) consisting of several clinical cases. It warranted a detailed evaluation of all dietetic care process steps, starting with nutrition assessment. RESULTS: Results for motivation assessed during nutrition assessment are not consistently positively associated with outcome and the added value of assessing them at baseline is still unclear. However, depressive symptoms, emotional distress, and anxiety negatively affect eating and physical activity and therefore limit the efficacy of the dietetic intervention. Assessing behavioural components including nutrition literacy is an important precondition for influence on behavioural modification. CONCLUSION: Indisputably, baseline assessment of behavioural components and factors influencing behaviour are important to increase the therapeutic efficacy of personalized dietetic interventions.

Assessment Practices for Dietetics Trainees: A Systematic Review.

High-quality education is essential to produce competent graduates in the field of dietetics. Assessment is a fundamental component of education and driver of learning, yet little is known about methods used to assess dietetics trainees. The objective of this review is to evaluate the practices and outcomes of methods used to assess dietetics trainees. A systematic review of the literature was undertaken. MEDLINE, the Cumulative Index to Nursing and Allied Health Literature Plus, Embase, and the Education Resources Information Center databases were searched from inception until May 31, 2017, using key terms that identified studies reporting practices for the assessment of dietetics trainees. Abstract and title screening was completed by three independent reviewers followed by full-text screening using the eligibility criteria. Quantitative and qualitative data were extracted. Study outcomes were evaluated using Miller's Pyramid, Kirkpatrick's Hierarchy, and the principles of programmatic assessment. Thirty-seven studies were identified. Assessments targeted all levels of Miller's Pyramid with the does level being the most prevalent (n=23). Most studies focussed on evaluating Level 1 (participation) (n=16) and Level 2b (n=16) (knowledge and skills) of Kirkpatrick's Hierarchy. Studies described single assessment instruments that focussed on instrument validity and reliability. Few studies considered a program of assessment or the role of expert judgment. Six themes were identified from qualitative data: (1) assessment for learning and professional development, (2) assessment requires motivated and skilled assessors, (3) trainees value authentic and global assessment, (4) assessment is evolving and context-sensitive, (5) poor assessment has negative implications, and (6) assessment evokes an emotional response. Studies focused on the development and evaluation of single quantitative-based instruments applied in isolation, with low-level outcomes sought. There is room to improve practices and design programs of assessment that combine quantitative and qualitative data for meaningful trainee feedback and credible assessment decisions. Comprehensive evaluation of assessment practices is required and must consider the contribution to improved health outcomes in all practice settings.

The Impact of Fellowship in Dietetics on Clinical Practice.

Medical nutrition therapy (MNT) in pediatric cancer treatment is essential. The Nutrition Department and the International Outreach Program at St. Jude Children's Research Hospital in Memphis, TN have worked together from 2005 to 2013 to develop and implement a training program for international dietitians working with pediatric oncology patients. During that time, St. Jude hosted 15 dietitians from various countries for this 3-week-long program. The curriculum provided experience in nutrition risk screening, nutrition care process, nutrition for cancer prevention, palliative care, and exposure to nutrition support. Monthly online meetings were established through the Cure4Kids website to continue collaboration and training. Learning outcomes were developed, and the impact of the program was evaluated based on changes made by former fellows in clinical practice, research, management, and food service upon return to their country. In addition, the program was evaluated based on recognition by the medical team, professional growth/networking, and personal growth. The survey return rate was 100%: responses revealed that 80% of participants continued working in pediatric oncology, 67% participated in monthly meetings, 47% collaborated on research, 100% advanced their competency in clinical practice, 93% broadened their competency in research, 67% became increasingly competent in management, 60% implemented changes in food service, 100% were recognized for participating in the program, and 100 and 93% noted that participation in the fellowship program helped their professional and personal growth, respectively. The psychological impact of the training on healthcare providers was as important as the impact of the program on patient care.

Exploring Social Justice Advocacy in Dietetic Education: A Content Analysis.

PURPOSE: To explore the extent to which knowledge- and skill-based learning regarding social justice and/or social justice advocacy is included in the course descriptions of required courses of accredited, English-speaking dietitian training programs in Canada. METHODS: This study is a mixed-methods content analysis of required course descriptions sampled from university academic calendars for accredited, English-speaking dietitian training programs across Canada. RESULTS: Quantitative analysis showed that required course descriptions (n = 403) included few instances of social justice-related terminology (n = 63). Two themes emerged from the qualitative analysis: competing conceptualizations of social issues and dietitians' roles; prioritization of science-based knowledge and ways of knowing. CONCLUSIONS: Accredited, English-speaking dietitian training programs in Canada appear to include little knowledge- or skill-based learning regarding social justice issues and advocacy. Supporting future dietitians to pursue leadership roles in redressing social injustices and socially just dietetic practice may require more explicit education and training about social justice issues and advocacy skills.

A dietetic clinical educator enhances the experience and assessment of clinical placement.

AIM: The aim of this study was to evaluate the impact of a Clinical Educator model on the learning experience and environment for students, preceptors and managers. METHODS: A Clinical Educator position was established for the 10-week dietetic clinical placement at Edith Cowan University. The Clinical Educator was responsible for overseeing the placement and assisting in the supervision of students. A qualitative descriptive approach using focus groups with purposive sampling explored the research question. Students (n = 10), preceptors (n = 21) and managers (n = 3) participated in separate focus groups. Data were thematically analysed with consideration given to participant and focus group commonalities and differences. RESULTS: The findings revealed that the Clinical Educator (i) reduced the logistical burden of student placements and improved time efficiency; (ii) facilitated student assessment within a programme of assessment; (iii) was uniquely positioned to provide support and enhance student confidence; and (iv) enhanced capacity to manage underperforming and challenging students. CONCLUSIONS: The Clinical Educator model increased student confidence, facilitated quality assessment and supported the management of underperforming students. This was achieved by reducing the burden of clinical placements, facilitating effective and timely communication between stakeholders and supporting the establishment of meaningful relationships which enriched learning. The results highlight the importance of the people involved in placement to facilitate a positive student learning environment and high quality assessment.

Using unfolding case studies to better prepare the public health nutrition workforce to address the social determinants of health.

OBJECTIVE: The public health nutrition workforce has been reported to be underprepared for practice. The present study aimed to test the ability of an unfolding case study approach to support the public health nutrition workforce for the workplace, with a focus on improved access to nutritious food. DESIGN: Two unfolding case studies were trialled with undergraduate students in two-hour workshops to enhance their capability to address access to nutritious food as a social determinant of health. The approach provided information about the case using a staged approach that supported learners to review and reply to information and then continue this process as the case became increasingly complex. SETTING: Melbourne, Australia.ParticipantsThirty-eight undergraduate nutrition and dietetics students. RESULTS: The analysis revealed that the unfolding case study approach provided a place to challenge and deepen knowledge and think about the application of theory. As the cases developed and became more challenging, students were supported to consider appropriate approaches and recognised the constant evolution and dynamic nature of practice. CONCLUSIONS: This learning activity challenged students and supported deep learning about possible solutions. It may also be useful at a graduate level and for continuous education of nutritionists and/or dietitians to empower the workforce to address the social determinants of health, rather than just acknowledging them as a set of barriers that prevent people and communities from achieving optimal health. Further work is required to investigate how unfolding case studies in curricula shape preparedness for practice of public health nutrition.

Are Dietitians Documenting Malnutrition Based on Subjective Global Assessment Category?

Purpose: This study reports on dietitian use of the Nutrition Care Process Terminology (NCPT) diagnosis of malnutrition based on Subjective Global Assessment (SGA). Methods: Nutrition assessment reports for adults in medical, surgical, and cardiac units in 13 Canadian hospitals were retrospectively examined for a 6-week period in 2014. Reports with a SGA and NCPT diagnosis were included regardless of why the patient was seen by the dietitian. Results: Of the 932 nutrition assessment reports, 857 (92%) included an SGA. Based on SGA, the prevalence of mild to moderate malnutrition (SGA B) and severe malnutrition (SGA C) was 53.4% (n = 458) and 10.0% (n = 86), respectively. When categorized as severely malnourished, the most common NCPT diagnoses were "malnutrition" (n = 55, 72.4%), "inadequate oral intake" (n = 11, 14.5%), and "inadequate protein-energy intake" (n = 10,13.1%). Among those with SGA B and C, the assignment of the NCPT malnutrition diagnosis was 19.8% (n = 95). Conclusions: Dietitians play a key role in the prevention, identification, and treatment of malnutrition in the hospitalized patient and are well positioned to take a leadership role in improving its documentation. Ongoing audits, staff support, and training regarding NCPT use may improve the application of the malnutrition diagnosis. Future research examining dietitian barriers to using the malnutrition diagnosis would be valuable.