Making the Evidence-Based Case for Clinical Site Participation in Clinical Education: An ASAHP Clinical Education Committee Project.

BACKGROUND: Competition for clinical education sites is a known challenge for academic programs in allied health education with clinical sites reporting a variety of reasons for declining to participate in clinical education. In 2022, the Clinical Education Task Force (now Clinical Education Committee, CEC) of the Association of Schools Advancing Health Professions embarked on a project with the objective of creating an evidence-based resource that could be used by multiple professions to support the case for site participation in clinical education. METHODS: A literature search was conducted to identify contemporary published works on the positive impact of student clinical education placements on clinical sites. The publications were reviewed and four overarching themes were identified: students add value, productivity, preceptor perception, and patient perception. RESULTS: A one-page infographic was created to feature the four identified themes. A QR code embedded into the infographic links to the citations on which the themes are based. CONCLUSION: The one-page resource created by the CEC can be used to frame conversations about participation in clinical education, elevating the assertion of benefits from anecdotal to published-based claims. The resource is dynamic, as it can be updated continually as new information emerges and other information becomes outdated.

Health Professional Perspectives about the Future of Clinical Education: An ASAHP Clinical Education Committee Report.

In 2018, the Clinical Education Task Force (CETF) of ASAHP presented five recommendations to address clinical education needs. In 2019, the ASAHP Interprofessional Education Task Force (IPTF) established a regional summit for academic and industry constituents to improve health professional education and training. This article describes the steps taken to render a one-day St. Louis regional summit to receive stakeholder feedback on the nationally published recommendations for clinical education. The electronic survey was distributed to potential summit attendees about the CETF recommendations. Data categories captured included demographic details and questions about priorities, use, and engagement with the recommendations, and one open-ended question for each of the recommendations invited respondents to provide feedback. There were 349 respondents: 34% clinical preceptors/coordinators/directors, 31% academic program faculty, and 18% administrators. Common themes included the establishment of common goals between academic programs and healthcare organizations for partnership building, better recognition of the value of interprofessional collaborative practice, and technology as vital to the evolution of the healthcare system. Future directions should include regional summit meetings to address the implementation of the CETF recommendations relative to regional and localized challenges. Consensus-building efforts should address the diversity in responses relative to interprofessional collaborative efforts and clinical education research.

Survey of current job functions of renal dietitians.

OBJECTIVE: This cross-sectional study examined the current job functions of renal dietitians in relation to their demographic characteristics. SETTING AND PARTICIPANTS: Seven hundred and forty-seven dietitians of the Renal Dietitians Dietetic Practice Group of the American Dietetic Association and Council on Renal Nutrition of the National Kidney Foundation completed an electronic survey. Of 2566 surveys distributed, 29.1% (n=747) were returned and useable. MAIN OUTCOME MEASURE: Descriptive and inferential statistics were used. We performed chi(2) tests to identify relationships between reported job functions and demographic characteristics. Fisher's exact tests were used when greater than 20% of cells had an expected frequency of less than five. RESULTS: Dietitians' job functions were related to demographic characteristics. Dietitians with greater than 10 years of renal-dietitian experience were more likely to evaluate urea kinetic modeling frequently (chi(2)=32.95, P < .0005), or evaluate dialysis adequacy (chi(2)=24.16, P < .0005), than those with less renal-dietetics experience. Dietitians who worked in an outpatient facility were more likely to prescribe a renal diet frequently (chi(2)=13.39, P < .0005), recommend renal vitamins (chi(2)=9.81, P=.002), or evaluate interdialytic weight gain, or IDWG (chi(2)=32.24, P < .0005), versus those who did not work in an outpatient facility. CONCLUSIONS: This study documented the frequency of dietitians performing job functions related to renal dietetics. The results of this study document the variability in the role of renal dietitian, and suggest differing levels of practice within renal dietetics.

High School Students' College Outcomes in a Dual Enrollment Program, 1998-2015.

AIMS: This paper examines the college outcomes of dual-enrolled high school health science careers' students from 1998 to 2015. METHODS: For this retrospective descriptive evaluation of the program, the university requested from the National Student Clearinghouse (NSC) data on 6,831 students who had earned college credit through the Rutgers high school program. Descriptive statistics were used for analysis using Excel. RESULTS: Final dataset had 5,315 students, with 3,339 students who had been in college long enough to graduate. Of the 2,358 (71%) who had graduated from college, 62% (1,470) completed their associates or bachelor's degrees within 2 or 4 years, while an additional 25% (581) finished their respective degrees within 3 to 6 years. Students attending 2-year colleges had a 42% overall, on-time graduation rate, and students attending 4-year colleges had a 95% graduation rate. One or more health professions degrees were earned by 36% (862) of graduated students. DISCUSSION: College degree completion rates of these students are better than national performance and many students entered health careers. This paper adds to the literature on design and outcomes of dual high school/college enrollment at a time when states are expanding these partnerships.

Clinical Education in Transition: Recommendations and Strategies: A Report of the ASAHP Clinical Education Task Force.

The practice models, interdisciplinary team functions, intersecting competencies, economies, and settings of contemporary healthcare are all in flux, demanding that educators reconsider traditional health professions clinical education models and partnerships. The Association of Schools Advancing Health Professions (ASAHP) and Allied Health (AH) deans, collectively and individually, must determine the priorities and strategies to advance AH education. This paper offers five recommendations that stem from a review of literature pertaining to current changes in the healthcare sector and higher education that challenge the availability of AH clinical education. Vetted by AH educators and health system representatives, the recommendations subsume proactive strategies that target factors affecting learning in the clinical environment and aim to meet the needs of patients/clients, employers, students, and educators. The recommendations are: 1) Develop meaningful strategic partnerships with healthcare organizations; 2) Assess and integrate interprofessional competencies for efficient and effective interprofessional practice (IPP); 3) Incorporate effective use of healthcare technology into AH education and practice; 4) Advocate within and among healthcare systems, higher education leadership, accreditation and professional organizations, and governmental agencies to foster and support IPP competencies and effective cross-discipline referrals; 5) Drive excellence in clinical education through promotion of research and scholarly activity.

The Future of Clinical Education: Using Futuristic Scenarios to Explore Allied Health Deans' Perspectives on Clinical Education.

ISSUE: There is limited information and consensus on the future of clinical education. The Delphi technique was selected to identify agreement among Association of Schools of Allied Health Professions' (ASAHP) allied health deans on the future (2018-2023) of allied health (AH) clinical education. METHODS: Sixty-one AH deans, 54.9% (61 of 111) of the ASAHP membership, expressed opinions about clinical education through a three-round Delphi study. In conjunction with a conceptual model, four futuristic scenarios were used to encourage deans' feedback on the key factors impacting the future of clinical education. RESULTS: The responses to the four scenarios showed ways the external environment influences which activities the deans recommend. The results presented, by individual scenario and in totality, provide relevant and timely information on the importance and transformation of AH clinical education and its future. DISCUSSION: Futuristic scenarios, in combination with the Delphi technique, generated information where little exists specific to AH deans' perspectives on AH clinical education. The results offer deans opportunities for future strategic improvements. CONCLUSION: The use of the futuristic scenarios was suitable for guiding deans' responses and reaching agreement on the future of AH clinical education. These contributions reflect the imminent conditions and healthcare environment identified in the various scenarios and provide additional insight on key factors impacting the future for AH clinical education.

The Future of Clinical Education: Opportunities and Challenges from Allied Health Deans' Perspective.

ISSUE: There is limited information and consensus on the future of clinical education and the key factors impacting allied health (AH) clinical training. AH deans identified both opportunities and challenges impacting clinical education based on a proposed educational model. METHODS: From July 2013 to March 2014, 61 deans whose institutions were 2013 members of the Association of Schools of Allied Health Professions (ASAHP) participated in a three-round Delphi survey. Agreement on the relative importance of and the ability to impact the key factors was analyzed. Impact was evaluated for three groups: individual, collective, and both individual and collective deans. AH deans' responses were summarized and refined; individual items were accepted or rerated until agreement was achieved or study conclusion. RESULTS: Based on the deans' ratings of importance and impact, 159 key factors within 13 clinical education categories emerged as important for the future of clinical education. Agreement was achieved on 107 opportunities and 52 challenges. CONCLUSIONS: The Delphi technique generated new information where little existed specific to AH deans' perspectives on AH clinical education. This research supports the Key Factors Impacting Allied Health Clinical Education conceptual model proposed earlier and provides a foundation for AH deans to evaluate opportunities and challenges impacting AH clinical education and to design action plans based on this research.

Employers' Viewpoint on Clinical Education.

ISSUE: This qualitative study gathered the opinions of healthcare employers to better understand the importance, benefits, obstacles, and evolving issues related to allied health (AH) clinical education from the employers' perspective, with the goal to identify opportunities to strengthen and improve clinical-educational partnerships. METHOD: Member deans of the Association of Schools of Allied Health Professions (ASAHP) provided names and contact information of employers that routinely educate their students. Interviews were scheduled with employers who responded to Clinical Education Task Force (CETF) invitation. Twenty-one interviews were conducted by CETF members in early 2016 and analyzed utilizing qualitative software. OUTCOMES: Themes included benefits of working with students and hiring trainees, and obstacles of time and effort required to host students. A trend was noted in gaps between educational preparation and clinical performance. Recent changes highlighted increased technology and regulation, while anticipated changes included more focus on learning on site, longer clinical experiences, and payment for clinical education. CONCLUSION: Collaboration between educators and employers is essential to ensure that curriculum and outcomes match the needs of the field and effectively prepare students as entry-level clinicians.

The Future of Clinical Education: Using the Delphi Technique to Study Allied Health Deans' Perspectives on Definitions and Goals.

BACKGROUND: Allied health (AH) clinical education provides future health professionals with the experiences necessary to develop the healthcare competencies required for success in their individual fields. There is limited information and consensus on the purposes of clinical education, including its definition and goals, and its comprehensive role in AH clinical training. This study explored whether consensus could be achieved in the definition, goals, and factors impacting AH clinical education. METHODS: An expert panel consisting of 61 AH deans (54.9% of the population) whose institutions were 2013 members of the Association of Schools of Allied Health Professions (ASAHP) participated in a three-round Delphi study. From July 2013 to March 2014, the deans expressed opinions about clinical education and its purposes. Responses were collected, summarized, and refined, and responses were accepted and re-rated until agreement was achieved or the study concluded. RESULTS: The hypothesis that AH deans would agree upon the definition and goals of clinical education was supported by this study's findings. Over 90% of deans "strongly agreed" or "agreed" on the definition of clinical education. A majority (90.2% to 92.7%) agreed with the goals. CONCLUSION: High agreement was achieved on the purposes of clinical education, resulting in a comprehensive definition of and goals for AH clinical education. The definition and goals of clinical education can be added in the healthcare literature and used in support of AH education.

Functions performed by level of practice of registered dietitian members of the diabetes care and education dietetic practice group.

The purpose of this study was to examine current professional practices of registered dietitians (RDs) in the Diabetes Care and Education dietetic practice group (DPG), analyzed by levels of practice: entry-level, specialty-practice, or advanced-level. The results of the Diabetes Care and Education DPG 2002-2003 membership survey were used for this study. The study was limited to RD members of the Diabetes Care and Education DPG who completed the membership survey in its entirety. Frequency distributions, chi2, Fisher exact test, and cluster analysis were performed with a prior alpha set at .10. Sixty-one (5.0%) RDs were functioning as an entry-level practitioner, 851 (69.1%) were functioning as a specialty-practice practitioner, and 320 (25.1%) as an advanced-level practitioner. Significantly more advanced-level practitioners were performing more tasks compared with entry-level practitioners. Entry-level RDs performed a mean of 2.4 functions, specialty-practice practitioners performed 7.7, and advanced-level practitioners performed 11.6 functions. The results of this survey further delineated that RDs function at various levels of practice and that credentials for RDs increased as level of practice advanced.

Registered dietitians' use of physical assessment parameters in professional practice.

OBJECTIVE: To examine how registered dietitians who have completed one of two physical assessment programs use the knowledge and skills learned in practice and whether method of instruction had an affect on use of skills in practice. SUBJECTS/SETTING: Surveys were mailed to 891 persons, all of whom completed a Dietitians in Nutrition Support dietetic practice group or University of Medicine and Dentistry of New Jersey continuing education program. Four hundred seventeen surveys were returned and 407 were usable. STATISTICAL ANALYSIS: chi(2) analysis and stepwise logistic regression was used to analyze the data. Statistical significance was P=.05. RESULTS: Sixty percent of respondents worked in a clinic setting. Four of the five most-used competencies were similar between the two programs. More registered dietitians are using physical assessment competency information in clinical assessment, but not performing the competencies independently. Respondents with the Certified Diabetic Educator credential (P=.007) and Certified Nutrition Support Dietitians credential (P=.215) were more likely to use select physical assessment competencies. Confidence was reported as enhancing use of physical assessment competencies (n=153, 45%) and time was a barrier to using physical assessment competencies (n=159, 52%). APPLICATIONS/CONCLUSIONS: There were no significant differences in use of physical assessment competencies between the University of Medicine and Dentistry of New Jersey program and the Dietitians in Nutrition Support program. Although not statistically significant, there appeared to be more use of physical assessment competencies by those who received additional training and those who completed the University of Medicine and Dentistry of New Jersey program. This study reveals that registered dietitians are using the values in clinical assessment, however they must move to actually performing physical assessment competencies in practice.

PROP taster status and self-perceived food adventurousness influence food preferences.

OBJECTIVE: To determine the influence of 6-n-propylthiouracil (PROP) taster status and food adventurousness on liking of bitter, hot, and pungent foods. DESIGN: Self-reported survey of food likes/dislikes for 70 foods. Subjects were classified as tasters or nontasters of PROP using a standard screening procedure. By their response to a query regarding their perceived frequency of trying unfamiliar foods, subjects were characterized as being more or less adventurous. SUBJECTS: A convenience sample of 232 healthy adults, 18 to 55 years of age, was recruited from the local community. Statistical analyses Individual foods were grouped using Principal Component Analysis. Analysis of variance was used to assess differences in liking of food groups as a function of PROP status and food adventurousness. RESULTS: PROP tasters who were more food adventurous liked chili peppers and hot sauce, other pungent condiments, strong alcohol, and bitter fruits and vegetables more than tasters who were less food adventurous (P< or =.05-.001). Nontasters liked most foods, and food adventurousness had little influence on food liking for these individuals. CONCLUSIONS: Food adventurous PROP tasters liked a wide variety of strong-tasting foods, whereas tasters who were less food adventurous showed the classic dislike of bitter, hot, and pungent foods. Previous studies might have overestimated the influence of PROP taster status on rejection of strong-tasting foods by not distinguishing individuals by food adventurousness.

Applying social cognitive career theory to registered dietitian research involvement: a randomized controlled trial.

UNLABELLED: The purpose of this study was to measure the effect of a social cognitive career theory (SCCT)-based educational intervention combined with an evidence-based practice (EBP) continuing professional education (CPE) program (standard-plus group) as compared to the EBPCPE program alone (standard group) and a no-treatment control on research outcome constructs (research self-efficacy, research outcome expectations, research interest and research involvement) in dietitians. METHODS: This randomized controlled trial measured the effect of an online 14-week educational intervention, with measurements made pre- and post-intervention and at 3-month follow-up. A randomly selected list of registered dietitians (RDs), who reported clinical nutrition as their primary practice area, was obtained from the Commission on Dietetic Registration. Subjects (n=580) were randomly assigned to three study groups, and 47.2% (n=272) completed data collection. RESULTS: The treatment effect between the groups was significantly different for research self-efficacy (p<0.001) and research involvement (p=0.005), with positive effects observed in the standard-plus and standard groups. There were no significant effects for research outcome expectations and research interest. CONCLUSIONS: This is the first known application of SCCT to RD research involvement as a career-related behavioral outcome, and it demonstrated that a significant increase in research self-efficacy occurs following participation in an educational intervention on EBP.

What clinical activities do advanced-practice registered dietitian nutritionists perform? Results of a Delphi study.

Activities performed by advanced-practice registered dietitian nutritionists (RDNs) have yet to be clearly elucidated. The study aimed to gain consensus on the practice activities of advanced-practice RDNs who provide direct clinical nutrition care. A three-round Delphi study was conducted. Purposive sampling identified 117 RDN experts working as clinicians and/or managers in direct care settings that met inclusion criteria for advanced-level practice. In Round 1, 85 experts provided open-ended advanced-level practice activities linked to the Nutrition Care Process sections. Using content analysis, the responses were coded into activity statements. In Round 2, experts rated the essentiality of these activities. In Round 3, experts re-rated statements not reaching consensus while viewing their previous rating, the group median, and comments. Median ratings of 1.0 to 3.0 were defined as essential, 4.0 were neither essential nor nonessential, and 5.0 to 7.0 were nonessential. Consensus was reached when the interquartile range of responses to each question was <2.0. Seventy-six (89.4%) experts completed all rounds. From 770 comments, 129 activity statements were generated. All statements reached consensus: 97.7% as essential; 0.8% as nonessential; and 1.5% as neither. Of essential activities, 67.5% were highly essential with limited variability (median=1.0; interquartile range≤2.0). Advanced-practice RDNs' tasks are patient-centered and reflect complex care; involve a comprehensive and discriminating approach; are grounded in advanced knowledge and expertise in clinical nutrition; include use of advanced interviewing, education, and counseling strategies; and require communication with patient, families, and the health care team. The high-level of consensus from experts suggest advanced-level clinical nutrition practice exists and can be defined.

Position of the academy of nutrition and dietetics: ethical and legal issues in feeding and hydration.

It is the position of the Academy of Nutrition and Dietetics that individuals have the right to request or refuse nutrition and hydration as medical treatment. Registered dietitians (RDs) should work collaboratively as part of the interprofessional team to make recommendations on providing, withdrawing, or withholding nutrition and hydration in individual cases and serve as active members of institutional ethics committees. RDs have an active role in determining the nutrition and hydration requirements for individuals throughout the life span. When individuals choose to forgo any type of nutrition and hydration (natural or artificial), or when individuals lack decision-making capacity and others must decide whether or not to provide artificial nutrition and hydration, RDs have a professional role in the ethical deliberation around those decisions. Across the life span, there are multiple instances when nutrition and hydration issues create ethical dilemmas. There is strong clinical, ethical, and legal support both for and against the administration of food and water when issues arise regarding what is or is not wanted by the individual and what is or is not warranted by empirical clinical evidence. When a conflict arises, the decision requires ethical deliberation. RDs' understanding of nutrition and hydration within the context of nutritional requirements and cultural, social, psychological, and spiritual needs provide an essential basis for ethical deliberation. RDs, as health care team members, have the responsibility to promote use of advanced directives. RDs promote the rights of the individual and help the health care team implement appropriate therapy. This paper supports the "Practice Paper of the Academy of Nutrition and Dietetics: Ethical and Legal Issues of Feeding and Hydration" published on the Academy website at: www.eatright.org/positions.

Practice paper of the Academy of Nutrition and Dietetics abstract: ethical and legal issues of feeding and hydration.

It is the position of the Academy of Nutrition and Dietetics that individuals have the right to request or refuse nutrition and hydration as medical treatment. Registered dietitians should work collaboratively as part of an interprofessional team to make recommendations on providing, withdrawing, or withholding nutrition and hydration in individual cases and serve as active members of institutional ethics committees. This practice paper provides a proactive, integrated, systematic process to implement the Academy's position. The position and practice papers should be used together to address the history and supporting information of ethical and legal issues of feeding and hydration identified by the Academy. Elements of collaborative ethical deliberation are provided for pediatrics and adults and in different conditions. The process of ethical deliberation is presented with the roles and responsibilities of the registered dietitian and the dietetic technician, registered. Understanding the importance and applying concepts dealing with cultural values and religious diversity is necessary to integrate clinical ethics into nutrition care. Incorporating screening for quality-of-life goals is essential before implementing the Nutrition Care Process and improving health literacy with individual interactions. Developing institution-specific policies and procedures is necessary to accelerate the practice change with artificial nutrition, clinical ethics, and quality improvement projects to determine best practice. This paper supports the "Position of the Academy of Nutrition and Dietetics: Ethical and Legal Issues of Feeding and Hydration" published in the June 2013 issue of the Journal of the Academy of Nutrition and Dietetics.

Clinical education from a specialized accreditation viewpoint: a report of the ASAHP clinical education task force.

UNLABELLED: Access to clinical education poses national challenges to allied health training programs. Clinical education is paramount to providing future health professionals with experiences that support competencies for success in their individual fields. METHOD: The ASAHP Clinical Education Task Force interviewed 14 executive directors of various specialized accreditation agencies on clinical education issues and opportunities. RESULTS: Interview questions were compiled and analyzed by members of the task force. Similarities across disciplines were found on the high value of clinical education, key reasons for clinical education, and the expansion of interprofessional education. Major differences included the use of simulation and its replacement for clinical hours, measurement of quality of education and student feedback, and the use of portfolio assessment. DISCUSSION: Of 14 professions surveyed, all respondents regarded clinical education as "very important" to student competency and certification. A common theme was that decisions regarding clinical education were under the auspices of the training programs as long as students were able to demonstrate specified competencies as per the standards in each field. Most directors acknowledged the need to accommodate changes in clinical education methodology and some discussed related changes in accreditation requirements. CONCLUSION: The 100% participation by executive directors spoke to the willingness of the accreditation agencies to share information on education of the future healthcare workforce. The clinical education environment is poised for innovation in methods to teach skill development and build competencies. ASAHP partnership and teamwork with specialized accreditation agencies is a fruitful avenue for creating and maintaining excellence in clinical education.

Framework for analyzing supply and demand for specialist and advanced practice registered dietitians.

The number of credentialed dietetics specialists--approximately 15% of the profession--is proportionately higher than those in other allied health and nursing professions. Credentialed specialists seem to receive greater compensation earlier in their career, but this advantage neutralizes as length of time in the profession increases. A larger proportion of younger registered dietitians (RDs) are specialists, which may mean an increase in supply of specialists in the future. There is considerable interest in creation of health promotion and foodservice management credentials. Consideration should be given to collaborating with other organizations to explore new models of recognition or credentialing for narrow areas of focus. Creating a methodology that can differentiate the tasks and approaches to practice that are unique to advanced practitioners compared with specialists has been a challenge. Prior research has not succeeded in identifying the differences in what advanced practitioners do. Future research to isolate advanced practice must take practice approach into account. A new, research-based, credential for advanced practitioners is possible, or a recognition program for advanced practice RDs could be considered. Precise supply and demand for specialty and advanced practice RDs cannot be measured. Thus, in this technical article, the authors share the available information regarding supply and demand with regard to dietetics specialists and advanced practitioners. It seems there are distinctions among the various levels of practice and recognition of their value to the profession and to the health of the public.