New Dietetic Practitioners’ Perspectives: On Their Education and Training

Exploring Student Perspectives of the Dietetics Profession Using a Professional Socialization Lens

Purpose: We aimed to explore student perspectives of the dietetics profession using a professional socialization lens.Methods: We conducted qualitative semi-structured interviews, virtually or by phone, with 25 dietetic undergraduate/graduate students or interns in 2020/21. Transcripts were thematically analyzed.Results: All participants identified as female, averaged 25 years old at the time of the interviews, and were in different stages of their education. Two themes captured their perspectives of the profession: dietitians have technical expertise and professional identities are evolving. Technical expertise was focused on scientific understandings of how individuals consume and utilize food, and how (mostly Western) food should be prepared for safety and maximum nutrition. Participants perceived dietetics as a white, feminized profession with dietitians' role to aid in weight loss; participants actively sought to resist these stereotypes, notably through social media.Conclusions: While holding technical expertise continues to be embedded as a key component of dietetics identity, student professional socialization is also being shaped by social media, racial justice, and body positivity movements. This socialization process is likely to influence changes to the profession as students enter practice.

An Exploration of Dietetic Students' Experiences in a Noncourse-based Service-Learning Opportunity in a Canadian Academic Setting

Purpose: To investigate the experiences of dietetic students in a faculty-supervised, noncourse-based service-learning (NSL) opportunity called Nutrition Ignition! (NI!) to understand how NSL activities contribute to dietetic education.Methods: This study used focus group methodology. A convenience sample was recruited from current members of NI!. Participants completed a brief demographic questionnaire and then engaged in a focus group discussion led by a trained moderator who followed a semi-structured guide. Six focus group discussions were transcribed, and a common theme template was developed by researchers.Results: Out of 46 eligible members of NI!, 33 agreed to participate. The main reasons participants joined NI! were to develop professional skills and to help children in the community. Participants discussed many outcomes from their participation in NI!, including enhanced communication skills, especially in terms of knowledge translation; increased ability to be flexible and adapt to "real-world" situations; deeper awareness of the research process; and expanded world view.Conclusion: This study suggests that NSL is an effective way to build dietetic students' personal and professional skills and provide an additional opportunity in academic settings to prepare dietetic students for entry-level practice.

Preparedness for advancing future health: a national qualitative exploration of dietetics graduates' experiences

Effective health workforce preparation is critical to the health of those who stand to benefit from its services. Emerging dietitians can provide important insights on an evolving workforce that is well-placed to advance future global health. This study aimed to explore a national sample of dietetics graduates' experiences of, and challenges faced in, dietetics workforce preparation and preparedness in Australia. An interpretive description methodology guided this study whereby researchers interpreted the meanings that participants attributed to their experiences. Twenty dietitians (graduated within the last 2 years) were purposively sampled from across Australia and detailed insights were obtained through semi-structured interviews. A multi-analyst approach employing thematic and template analysis, enabled five themes to be identified across the data set. These included: (1) being held back; (2) chasing the prize; (3) valuing real learning; (4) easing the transition; and (5) encountering influencers. While graduates appreciated their preparation, they were not empowered or equipped to embrace opportunities in diverse and emerging areas of dietetics practice. Graduates were challenged by the competitive landscape of securing obvious job opportunities and by a lack of support in transitioning into the workforce. Practice exposures and encounters with influential dietitians were highly valued. Research on role-emerging dietetics placements along with enhanced support mechanisms for novice dietitians is urgently required to ensure appropriate alignment between future dietetics preparation and practice. Obtaining insights into health professional graduates' experiences of their education can be used to ensure that emerging health workforces are relevant and responsive to future market needs.

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

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

Dietetics students' experiences of dietetics workforce preparation and preparedness: a systematic review and qualitative synthesis

BACKGROUND

Dietetics students are a widely researched group. As emerging dietitians, they can provide valuable insights to inform how dietetics education programmes may be enhanced to meet contemporary healthcare needs. This review aimed to systematically synthesise dietetics students' experiences of dietetics workforce preparation.

METHODS

MEDLINE, CINAHL, Embase, PsycINFO, ERIC, Informit and ProQuest Dissertations and Theses Global were searched to identify research published until June 2017. Studies investigating dietetics students' experiences of dietetics workforce preparation, and employing qualitative data collection and analysis methods were included. Data analysis was guided by thematic synthesis, where themes were constructed through an iterative and inductive process. Study quality was appraised using the RATS Qualitative Research Review Guidelines.

RESULTS

From the 3301 records identified, five studies met the inclusion criteria and the views of 120 dietetics students from two countries over a 9-year period were synthesised. The overarching theme of 'navigating through the ups and downs' was underpinned by four main themes: enduring hurdles; reconciling expectations; transforming self; and making and breaking connections. Quality appraisal results rated selection bias as being inadequate/inappropriate across all studies.

CONCLUSIONS

Dietetics students undertake a transformational journey through dietetics education. They are inspired by seeing what is possible through meaningful encounters with practitioners in diverse settings. However, they are challenged by competitive environments and perceived ideals that are embedded in the profession. Strategies that focus on exposing dietetics students to inspirational practitioners, increasing and celebrating diversity in academic/placement settings, and incentivising collaboration across dietetics education, could act as catalysts to enhance the experience of future dietetics students and the nutrition-related health of those they will serve.

Challenges in preparing the dietetics workforce of the future: An exploration of dietetics educators' experiences

AIM

Dietetics educators represent a small but influential workforce group that has experienced significant change in recent years. The workforce development challenges faced by this group have been largely unexplored. The present study aimed to explore the experiences of, and challenges faced by, academic dietetics educators in preparing dietitians for the workforce.

METHODS

The approach taken in the present study was informed by qualitative description. Fifteen dietetics educators employed by 13 universities across Australia were purposively sampled. In-depth, semi-structured interviews conducted via telephone (n = 12) or face-to-face (n = 3) were digitally recorded then transcribed verbatim. Data were managed with NVivo and inductively analysed using open coding. Codes were condensed into themes through an iterative process involving multiple researchers.

RESULTS

The overarching theme of 'aiming for a moving target' was underpinned by the themes of: (i) striving for betterment; (ii) bridging dissonance and (iii) distressing impossibilities. Interviewees described how they were driven to enhance the preparation of dietitians but acknowledged disparity between what graduates are being prepared for and what they need to be prepared for. Heightened expectations of others, professional constraints and a lack of collegiality among the profession were among the challenges that manifested in a sense of frustration, concern and isolation.

CONCLUSIONS

Dietetics educators are motivated to shape and enhance the future profession. However, they face numerous challenges in their efforts to prepare graduates who are well-equipped for increasingly diverse dietetics practice. Strong leadership, academic collaboration and greater engagement of the broader workforce are required for the benefit of the entire profession.

Does the Transformation of Dietitians from Counseling to Therapy Also Apply to the Physical and Therapeutic Environment? A Case Study of Israeli Practice

BACKGROUND

Lifestyle change can be influenced through effective interaction between care receiver and care provider. The physical environment where the interaction occurs can affect the dynamics of long-term therapeutic treatment. There have been no studies on the perception of the physical environment in nutritional treatment.

OBJECTIVE

Our aim was to ascertain the impact of the physical environment on the dynamics and communication between dietitian and patient based on perceptions of dietitians.

DESIGN

We conducted qualitative constructivist phenomenological research.

PARTICIPANTS

In-depth interviews (n=10) and eight focus groups (n=62) were held with dietitians who offer treatment in a physical environment designed according to the medical model and/or in a physical dynamic environmental design according to the dynamic model.

RESULTS

Most dietitians in Israel treat their patients in a physical environment arranged according to the medical model. The participants reported that the physical environment affects the interaction. However, the idea of transforming the physical environment according to the dynamic model raised reservations. Barriers include upsetting therapeutic boundaries, challenging professional authority, and lack of therapeutic tools suitable for the change.

CONCLUSIONS

Changes in the spatial design in which the therapeutic interaction occurs might support the dietitians' transformation from counseling into therapy. The barriers toward such change suggest that professional training is needed to enable dietitians to overcome them. We recommend conducting further research to evaluate the current physical environment, as well as raising dietitians' awareness and training them to work in the new environment, reflecting a counseling/therapeutic mindset. These changes should be followed by additional research among practitioners to report on their effects.

The Nature of Competition in Dietetics Education: A Narrative Review

The impact on student development associated with being part of a competitive program is an emerging finding in dietetics research. As such, a narrative review of relevant literature was conducted pertaining to competition in post-secondary programs and the educational experience of students with respect to developing a career in dietetics. The review was guided by 2 questions: How is competition experienced by students? What strategies can reduce competition among dietetics students within the educational experience? A refined literature screening process justified including 32 articles in the review. The overall review findings suggested that, across dietetics programs, the outcomes of competition negatively impacted students' personal identity, motivation in the learning process, and involvement behaviours, including collaboration among students, participation in academic opportunities, and student relationships with faculty. The implementation of strategies conducive to addressing the effects of excessive competition and building a supportive academic environment, for example increasing collegiality and engaging students in intrinsic learning, are important for continued growth of the dietetics profession. Educators can reflect on the complex nature of competition and how the effects of excessive competition may be in opposition with the competencies that students are expected to develop as professionals.

[In Process Citation]

PURPOSE

The main objective is to examine the perception Quebec nutrition students have of the future of the profession based on critical incidents they have reported.

METHODS

An electronic questionnaire was sent to the 158 nutrition students graduating from the three Quebec universities offering a nutrition program. The critical incident technique was chosen as the qualitative method. A theme and subtheme table was devised from the analysis of the incidents and entered into Excel to synthesize the data. Results: Positive incidents were associated with the recognition of other professionals and clients, an understanding of the scope of the profession and related opportunities, and the impact of nutrition interventions. Negative incidents mainly pertained to lack of recognition, competition, the realization that employment opportunities are limited, work conditions, and the ability to assert their roles as dietitians. Most of the incidents reported occurred during practicums.

CONCLUSIONS

Leadership competencies should be developed to help dietitians take their place on care teams and create a space for themselves in the public sphere. Furthermore, practicum experiences are fundamental in the development of the image students have of the profession.

Food and Culinary Knowledge and Skills: Perceptions of Undergraduate Dietetic Students

PURPOSE

The objective of the current study was to examine food and culinary skills and knowledge of dietetic students.

METHODS

An online bilingual survey was created using Survey Monkey^TM to explore the skills, knowledge, and perceptions of undergraduate dietetic students regarding food and cooking. Chi-square and logistic regression analyses were used to compare skills and knowledge of food and culinary concepts.

RESULTS

The final sample included second- (n = 22) and third-year (n = 22) students within the Baccalauréat specialisé en sciences de la nutrition program at the University of Ottawa. There were no significant differences (P > 0.05) on 3 of 4 skills (preparing a cake, whipping egg whites, or baking a yeast bread) or knowledge concepts (fold, baste, braise, grill, and poach) amongst second- and third-year students. Third-year students perceived more skill in preparing a béchamel sauce. There was a trend for third-year students (59%) to have higher food and cooking skills and knowledge compared with second-year students (32%).

CONCLUSIONS

Perceived knowledge and confidence was proportional with the academic year, whereas overall knowledge and skills of food and culinary concepts were moderate among both groups of students. This research suggests that more dedicated time may need to be spent on food and cooking competencies in undergraduate dietetic education.

Impact of Registered Dietitian Expertise in Health Guidance for Weight Loss

BACKGROUND & OBJECTIVES

Expertise of registered dietitians (RDs) is important for health guidance but has been poorly evaluated. We evaluated the kind of RD expertise that would improve their skills.

DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS

This study was a post-hoc analysis of our randomized controlled trial, which compared the weight change between participants using the web-based self-disclosure health support and those using the email health support. Healthy men and women aged 35-64 years with a body mass index (BMI) of > = 24.5 kg/m2 were recruited for this study. We evaluated the relationship of RD expertise indicators including the duration of working as an RD, the experience of health counseling, and membership in the Japan Dietetic Association (JDA) with the weight loss of study participants. The primary endpoint was the change in body weight. Comparison of changes in body weight by the RD expertise indicators was evaluated using analysis of covariance.

RESULTS

A total of 175 participants were eligible for analyses. Changes in body weight were significantly greater when they were supported by the RDs in the routine counseling group than when supported by the RDs in the non-routine counseling group (-1.8 kg versus -0.4 kg, fully adjusted P = 0.0089). Duration of working as an RD and JDA membership did not significantly affect changes in body weight.

CONCLUSIONS

Among some indices of RD experience, the experience of providing routine experience of health counseling was associated with weight loss.

Exploring the Meanings that Dietitians Associate with their Role of Mother and Dietitian and How They Translate into Child-feeding Practices

PURPOSE

To explore the meanings that dietitians associate with their role of mother and dietitian and how they translate into child-feeding practices.

METHODS

The ideological case-study approach of Interpretative Phenomenological Analysis, a qualitative research design, was utilized. A convenience sample of 3 dietitians was recruited from the faculty of a university nutrition department. Dietitians participated in semi-structured interviews that were voice-recorded and transcribed. Data were thematically organized and interpreted using the theory of Symbolic Interactionism.

RESULTS

Five themes were developed: the evolution of food-related practices, tensions between the role of dietitian and mother, mealtime interaction, integration of dietetic values in child-feeding practices, and the individuality of the mother. Dietitian mothers used various parenting styles when interacting with their children. Their beliefs about best practice in child-feeding correspond with the recommendations of their dietetic profession. Their perception of what it meant to be a good mother was influenced by their identity as a dietitian.

RELEVANCE TO PRACTICE

Dietitian mothers need to be aware of the influence of professional discourse; professional thoughts can influence personal thoughts and actions related to child-feeding practices. Further exploration of the topic including maternal and child-feeding practices from the child's perspective is warranted.

Reflections on Perceived Preparedness of Dietetic Internship Graduates Following Entry into Practice

Purpose: To report on the perceived level of preparedness of dietetic internship (DI) graduates for entrance into practice as dietitians.

Methods: Graduates of an Ontario based, nonintegrated DI program from 2007–2011 who were at least 1 year postgraduation were surveyed to determine their level of perceived preparedness for practice using an electronic, content validated, self-administered questionnaire.

Results: Of 38 eligible graduates, 23 (61%) responded. Seventy-five percent of respondents were working as clinical dietitians, and 30% were working as community dietitians. Eighty-five percent of graduates reported feeling well or very well prepared for practice. Clinical and professional practice tasks were scored highest in terms of preparedness (ratings above 4.5/5) and research-related tasks such as using the research literature (4.1/5), making evidence-based decisions (4.2/5), and engaging in practice-based research (4.1/5) scored lower. Training gaps identified by 32% of respondents included community nutrition and management skill training.

Conclusions: Overall, results indicate that this DI program provides a positive training experience that prepares its graduates for entrance into practice as dietitians. Qualitative comments identifying gaps and improvements have guided changes to the curriculum including strengthening community-based placements. Post-graduate surveys represent an important tool in assuring that training programs evolve to meet the needs of students entering the workforce.

Dietitians’ Perceptions of Precepting: Knowledge, Skills, Attitudes, Barriers, and Training

Purpose

The extent to which dietitians agreed or disagreed with key informants’ perceptions of precepting knowledge, skills, and attitudes (KSA), training needs, and barriers was determined.

Methods

A 98-item survey was developed and distributed electronically to Dietitians of Canada members (n=5376).

Results

Of the 750 respondents who completed the survey (14% response rate), more than 95% agreed that preceptors should have knowledge of promoting learning and skills acquisition, and of learner assessment and evaluation. More than 90% of respondents agreed that preceptors should have skills in planning, teaching, coaching, research, facilitation, and evaluation. Differences in respondents’ perceptions of preceptor participation in practice-based research differed with years of experience. Respondents with fewer than five years of experience had a higher level of agreement that preceptors should participate in practice-based research than did those with more experience (P<0.05). Respondents indicated that barriers to precepting training were insufficient time (93%) and work environments not supportive of precepting (64%).

Conclusions

The findings articulate the KSA, training needs, and barriers to precepting considered significant for dietitian preceptors. The results are important for the advocacy for resources to support the training and development of preceptors, upon whom sustainability of the profession depends.