Minority Interns’ Experiences During Their Dietetics Education and Their Recommendations for Increasing Diversity in Dietetics: Findings from Structured Interviews

Diversity among racial minorities and males has remained limited in the dietetics field. Structured interviews with eleven minority interns were conducted to assess their experiences throughout their dietetics education and to examine their perceptions of the dietetics profession. General themes were reported. Dietetics was not the first career choice for six interns. Work and volunteer experience were perceived as the most influential factors in their selection for a dietetic internship. Some perceived being the only minority in an internship program and the lack of minorities on internship selection committees as problems. Increasing minority dietitians’ visibility at career days and early recruitment of students were suggested as ways to increase diversity within the profession. Resources such as the Building Our Future Mentor Program Tool Kit should be utilized to establish mentoring programs for students and to enhance diversity efforts in dietetics. J Am Diet Assoc. 2002;102:1674-1677.     

Perceptions of competency attainment in community dietetics: academic Plan IV vs. dietetic internship

A national survey of Plan IV representatives, internship directors, and dietetic interns was conducted to determine the perceived level of competence in community dietetics upon completion of academic coursework. Interns also rated their perceived competence in community dietetics near the end of internships. All major and specific responsibilities from the ADA Role Delineation and Verification for Entry-Level Positions in Community Dietetics were included in the survey questionnaire. Completed questionnaires were received from 447 dietetic interns (60%), 47 internship directors (57%), and 59 Plan IV representatives (39%). Highly significant differences were found among the three groups, with Plan IV representatives' expectations highest and students' lowest. Work experience prior to internship affected mean ratings on selected responsibilities. Unlike the results of the previous studies in clinical dietetics and foodservice systems management, the ratings in community dietetics did not reach their highest until the last month of the internship. Findings from all three areas of dietetic practice suggest that students' perceived competence is considerably lower upon completion of Plan IV than after completion of an internship, indicating need for defined work experience. Different teaching techniques, i.e., lecture vs. hands-on, could be related to different ratings of perceived competence within and between practice areas.     

Perceptions of competency attainment in clinical dietetics: academic Plan IV vs. dietetic internships

A national survey of all Plan IV representatives and dietetic internship directors in programs with a general or clinical emphasis was conducted to determine the level of competence in clinical dietetics expected of Plan IV graduates. Dietetic interns were asked to rate themselves on competency attainment at the beginning and near the end of the internship. The ADA's Role Delineation Study for Entry-level Personnel in Clinical Dietetics was used as the basis for the survey questionnaire. Completed questionnaires were returned by 137 Plan IV representatives (54%), 71 dietetic internship directors (75%), and 530 dietetic interns (62%). Highly significant differences were found among the three groups. Plan IV representatives had higher expectations of students than internship directors. Interns consistently rated their competency levels for all responsibilities below those indicated by either group of directors. All three groups indicated that students were better prepared for client-focus responsibilities than for professional or organizational-level responsibilities. Interns' self-ratings suggested that similar amounts of learning occurred in each of the three areas during the internship. Nutrition-related work experience immediately prior to the internship influenced students' perceived competency level at the beginning of the internship, but differences between those students and the ones with other or no work experience were overcome as students neared the end of their internships. For most major responsibilities, the students' perceived levels of competence did not change after the first few months of the internship.     

African-American students' perceptions of their majors, future professions, and the dietetics major and profession: a qualitative analysis

African-American professionals are underrepresented in the profession of dietetics. This preliminary qualitative study identified African-American students' perceptions of their majors, future professions, and the dietetics major/profession to understand why they did or did not enter dietetics. It was hypothesized that dietetics students chose dietetics primarily for altruistic reasons, whereas students in other fields of study did not choose dietetics due to lack of awareness of dietetics. To learn students' views, African-American college students engaged in elicitation interviews or focus group discussions. Twenty-eight women and 12 men participated. Phenomenologic analysis identified common themes and meanings: African-American students selected their majors for a variety of reasons, including desire to help people, interest in the field, recommendation from an adult, and family influence. African-American students in fields of study other than dietetics believed that the dietetics major was not selected due to lack of awareness about dietetics. Both dietetics students and students in other fields of study perceived versatility, ability to work with/help people, and to have an influence as positive qualities about their future professions. Advanced degree and training requirements, lack of diversity, and low salary were identified as negative qualities about future professions. African-American students in fields of study other than dietetics had not been exposed to the dietetics major, careers, and profession. Recruitment efforts should begin early to increase the number of African-American students in dietetics.     

Providing access to blacks and Hispanics in dietetics education

To increase the number of blacks and Hispanics in dietetics and three other health professions, the Health Sciences Recruitment and Retention Program was developed and implemented in 1985 by the College of Health at Florida International University in Miami. The coordinated undergraduate program assisted in a federal grant to accomplish the objectives of recruiting and retaining minority students. High school and community college students were recruited using a slide/tape presentation featuring black and Hispanic professionals. In addition, the college offered a summer course entitled "Perspectives of the Health Sciences Professions" to students entering their senior year in high school. In this course, students learned how dietitians, medical laboratory scientists, and physical and occupational therapists treat various disease states. Field trips and site visits provided additional exposure to the professions. A summer orientation and tutorial program was established to retain minority students enrolled in the coordinated undergraduate program. We recommend that this program be considered as a model for dietetics educators to use in developing other programs to increase the number of minorities in the profession.     

Factors affecting a student's choice of dietetics as a profession.

In order to design more effective recruitment strategies, 419 junior students in 38 coordinated dietetics programs completed self-administered questionnaires to identify factors that attracted them to the profession. The majority (43.9%) first became interested in a dietetics career while in college; 24.9% became interested before or during secondary school; and 17.7% were making a career change. Factors that most frequently led to a career in dietetics were a course in nutrition (32.9%), a friend or relative other than parent (31.0%), and a dietitian (30.3%). Students rated the opportunity to help others (95.2%) and the relationship of nutrition to health (94.0%) as characteristics of the profession that had a highly positive influence on their decision. Interests in health, disease, and health care (70.5%); teaching and health promotion (42.7%); sports and fitness (40.7%); counseling and behavior change (35.6%); and food and cooking (35.4%) were most frequently cited as influencing the choice of a dietetics career. Students were most interested in practicing dietetics as a consultant or in private practice (37.5%) or as a clinical dietitian (34.8%). New and innovative recruitment strategies should target high school and college students and pay special attention to second-career students. Interests such as health, disease, and health care and health promotion and characteristics of the profession such as the opportunity to help others attracted present dietetics students and should be emphasized in recruiting. The best marketing tools may be the practicing dietitian and a course in nutrition.     

Computer-based simulations enhance clinical experience of dietetics interns

OBJECTIVE: To determine the impact of computer-based simulations on the performance of dietetics interns in initial clinical rotations. DESIGN: Interns used either a simulation program (Care Planning Simulation System CPSS[) or a computer-based tutorial (Nutrition Care Planning Tutorial NCPT[) during their orientation. Performance of these interns on nutrition care skills was evaluated during their initial clinical rotations. SUBJECTS/SETTING: Participants were 108 dietetics interns from 8 different programs. Each internship had at least 8 interns, and none of the internships awarded a graduate degree. INTERVENTION: Subjects in the experimental group completed nutrition assessment and care planning activities for 3 simulated patients. Subjects in the control group completed a tutorial on assessment and care planning. MAIN OUTCOME MEASURES: Likert scale ratings of 31 behaviors were recorded by clinical preceptors. Behavior statements were grouped into 8 categories and average ratings for each category were determined. STATISTICAL ANALYSIS: Repeated-measures analysis of variance and linear regression were used to compare performance ratings between groups. RESULTS: There were no differences in overall evaluations of the simulation and tutorial groups for the 8-week period. Interns who started clinical rotations immediately after orientation (CPSS-I and NCPT-I groups) were rated lower in all categories than those who began their clinical rotations later (CPSS-D and NCPT-D groups). Maturation and acquisition of general skills likely influenced ratings of interns with delayed clinical rotations. For most categories of behavior the rate of improvement in rating scores was greatest for interns who used CPSS. APPLICATIONS: Computer-based simulations are a promising supplement to current techniques in didactic instruction and may be useful in both didactic and practice settings. Computer-based simulations can provide more varied practice experiences to didactic students and interns in preparation for more skilled entry-level positions in dietetics.     

Minority recruitment and retention in dietetics: issues and interventions

To better understand the reasons why minorities and males are underrepresented among registered dietitians (RDs) and dietetic technicians, registered, (DTRs) and to develop focuses for intervention, the investigators performed a telephone survey of newly credentialed RDs and DTRs and directors of RD and DTR education programs. Using lists of students recruited by the American Dietetic Association for participation in the survey, the investigators interviewed 83 RDs and DTRs and 20 education program directors. RDs and DTRs attributed minority underrepresentation primarily to the field's lack of visibility and underrepresentation of men to the traditional association with women. Education program directors attributed minority underrepresentation to educational disadvantages, particularly in scientific subjects. Findings from this study support program-level interventions such as increasing program flexibility, initiating outreach to K-12 schools and lower-division college students, providing tutoring in a nondemeaning atmosphere, and visibly expressing commitment to minority representation. More fundamental changes in the profession itself appear necessary for large-scale increases in minority representation. These include increasing internship opportunities; raising the profession's level of remuneration, prestige, and independence; increasing scholarship support; and advertising nationally through channels capable of reaching minorities.     

Incorporating hard boxes and soft bubbles into the dietetics curriculum

Dietitians have been challenged to learn the skills of creative thinking in order to become proficient managers in a rapidly changing world. We reviewed the literature to determine the prerequisites of creative thinking and assessed the management and administrative dietetics curriculum for our dietetic internship to determine whether those prerequisites were being met. A major concern in the dietetics profession is that students are not being adequately prepared to assume top management positions. A review of business school curriculums reveals that an emphasis on management theory and quantitative analysis does not adequately prepare students to function effectively in a world where creative problem solving is required. Effective managers at high levels of responsibility rely on intuition and hunches in addition to logical thought processes. Two thinking models are employed by managers--a rational one (hard box) and an intuitive one (soft bubble). These thinking models, or cognitive styles, can also be defined as left and right brain skills. Effective managers use left and right brain skills plus a combination of the two, or integrative brain skill. We reviewed the competencies, behavioral objectives, and planned experiences for the management level rotations of our dietetic internship to develop a conceptual model for the use of right, left, or integrative thought processes. We discovered that although integrative brain skills are used at all levels of our management rotations, especially the top management rotation, no rotation exclusively fosters right-brain skill development. A dietetic internship offers a fertile environment for developing the creative problem-solving skills that are required in management positions in the health care profession today.(ABSTRACT TRUNCATED AT 250 WORDS)     

Improving dietetics education with interactive communication technology

Changes occurring in health care, education, and technology are altering dietetics education. A model of learnercentered, cooperative, distance education based on interactive online technology is described for use in a dietetic internship. Evaluation of this model includes review of key-feature exams, results of computer attitudes surveys, use of the technology by interns, exit interviews, and performance on the examination for registered dietitians. In a pilot study of the model with 8 subjects, comfort using the Internet improved significantly. Use of interactive communication technology in dietetics education has the potential to improve competency, technological aptitude, professional partnering skills, and lifelong learning skills.     

Learning styles differ between senior dietetics students and dietetics faculty members

This study examined learning styles of faculty members and senior students in coordinated programs in dietetics and compared learning styles by area of career expertise (faculty) or interest (students). Respondents included 108 faculty members and 324 students. The survey included a standardized Learning Styles Inventory and questions regarding demographics and career preferences. chi(2) analysis was used to compare learning style with selected variables. Significant differences were found between student and faculty learning styles (P=.006). Faculty also had significant differences in learning styles within various areas of expertise (P=.037), but no significant differences were found in learning style by expected career choice of students. Students listed entry-level and 5-year career choices. Most (55.6%) plan to work in clinical nutrition following graduation, but 37.0% anticipate being in a nontraditional area of dietetics 5 years postgraduation. Only 6.8% plan to work in management at entry, dropping to 3.4% at 5 years.     

Continuous improvement in dietetics education with a regional advisory board: a model that works

Continuous improvement has been a focus of business and health care for years. The Commission on Accreditation for Dietetics Education has also identified the need for continuous improvement in dietetics education programs and requires them to seek outside counsel to help accomplish it. Most dietetics education programs develop advisory boards to provide this outside counsel, but finding individuals to commit to an ongoing advisory board can be challenging. Dietetics internship directors from dietetics practicum programs throughout Arizona created the Arizona Dietetic Practicum Advisory Committee (AzDPAC), which uses suggestions from preceptors, interns, and committee members to generate ideas for improvement. Since the conception of AzDPAC both tangible and intangible outcomes have occurred. Tangible outcomes include better coordination among programs, development of a combined annual affiliate meeting, standardization of forms, creation of a combined "Clinical Bootcamp," development of a Web page describing all programs, and better networking among interns from different programs. In addition, AzDPAC improved cooperation and sharing of expertise and created an available group of peers for new directors. An advisory committee of regional program directors is a model that works in providing dietetics education programs with ongoing outside counsel and ideas for continuous improvement.     

Promoting and evaluating competence in on-line dietetics education

Professional organizations, such as the American Dietetic Association are challenged to assure competency of their practitioners. Competency includes higher-level skills such as critical-thinking, cooperative work, effective communication, and use of lifelong learning resources. Information literacy via computer technology is a key component of competency, which needs to be included in dietetic education and training. This dietetic internship examined use of online technology to develop competency using the key-feature exam. Seventy-five dietetic interns from three different programs were divided into those with (n = 44) and without (n = 31) online instruction, to which pre- and post- test key feature exams were administered. Those with online instruction had greater improvement (P < 0.05) on key-feature exams in nutrition support and pediatric nutrition. Competency is complex and difficult to assess, thus tools to better assess the comprehensive scope of practitioner competency are needed. The key-feature exam may be a tool to assess and verify practitioner competency in dietetics professionals.     

American Dietetic Association: scope of dietetics practice framework

As a whole, the Framework provides a structure for our profession by describing the full range of resources available to us all, at every stage of development. At the broadest end of the spectrum, the Framework emphasizes the dietetics practitioner’s professional accountability and places decisions about boundaries of practice in the hands of the individual practitioner. It is intended to be used throughout the profession by students and educators, individual RDs and DTRs, people who have just entered the profession, people who have progressed to advanced or specialty practice, retired dietetics professionals who maintain the active RD or DTR credential, hiring managers, certification and licensure boards, national committee members, researchers, and anyone encountering new challenges at work. It serves as a tool for everyone who engages in the profession of dietetics. And, as we individually and collectively change to respond to new developments in the health care environment, so too will our Framework evolve over time to reflect this.     

Influences on the Selection of Dietetics as a Career

Objective To gather information on the factors that influence students’ decisions to choose dietetics as a career.Design Self-administered questionnaires regarding the point at which career decisions were made were completed by 1,695 students in Plan IV/V dietetics programs throughout the United States.Subjects All Plan IV/V dietetics programs that reported greater than five graduates in the academic year 1989 to 1990 were selected from the 1990-1991 Directory of Dietetic Programs for the sample population. Of the 156 schools that were mailed questionnaires, responses were received from 84 schools (54%). Almost 90% of the students were women, 10.6% were men.Statistical analyses Data were analyzed using the Statistical Package for the Social Sciences. A χ² analysis was used to examine the relationship between point of decision and factors that influenced career choice, including people who influence career choice.Results The majority of students (55%) questioned reported making their career decision in college. Students rated interest in nutrition (96.3%) and job enjoyment (93.8%) as factors that were important in their decision to pursue a career in dietetics. College catalogs were rated by 48.3% of the students as being either useful or very useful in helping them make their career selection. With respect to gender differences, women rated a diverse work environment as being very important to their career decision more frequently than men (χ²=15.44, P<.01). Women were more likely than men to rate part-time work opportunities as being very important (χ²=26.75, P<.001); and selected working with people as being very important to their career decision (χ²=17.59, P<.01).Conclusions Findings identified that recruitment strategies need to be audience specific. Because career decision making appears to occur during one of three time frames (high school, college, or work experience), recruitment activities should be developed to specifically target students at these times. One way to increase the exposure of students to the profession of dietetics is for registered dietitians to give guest lectures in introductory college courses and high school upper-class courses in health, home economics, and biology. The use of university/college catalogs as effective marketing tools should also not be underestimated.Data suggest that gender differences exist in factors that influence persons to choose dietetics as a career. To increase the number of men who pursue careers in dietetics, future research should be designed to more fully explore gender differences, so that strategies to recruit more men into the profession can be developed. J Am Diet Assoc. 1997: 97;254–257.     

Insights in Public Health: Public Health Laboratory Workforce Outreach in Hawai‘i: CLIA-Focused Student Internship Pilot Program at the State Laboratories

Chronically understaffed public health laboratories depend on a decreasing number of employees who must assume broader responsibilities in order to sustain essential functions for the many clients the laboratories support. Prospective scientists considering a career in public health are often not aware of the requirements associated with working in a laboratory regulated by the Clinical Laboratory Improvement Amendments (CLIA). The purpose of this pilot internship was two-fold; introduce students to operations in a regulated laboratory early enough in their academics so that they could make good career decisions, and evaluate internship methodology as one possible solution to workforce shortages. Four interns were recruited from three different local universities, and were paired with an experienced State Laboratories Division (SLD) staff mentor. Students performed tasks that demonstrated the importance of CLIA regulations for 10–15 hours per week over a 14 week period. Students also attended several directed group sessions on regulatory lab practice and quality systems. Both interns and mentors were surveyed periodically during the semester. Surveys of mentors and interns indicated overall positive experiences. One-on-one pairing of experienced public health professionals and students seems to be a mutually beneficial arrangement. Interns reported that they would participate if the internship was lower paid, unpaid, or for credit only. The internship appeared to be an effective tool to expose students to employment in CLIA-regulated laboratories, and potentially help address public health laboratory staffing shortfalls. Longer term follow up with multiple classes of interns may provide a more informed assessment.     

International perspectives: the profession of dietetics.

A survey about the professional characteristics of dietetics practice was mailed to 109 countries and representatives from 61 countries responded. Using the Human Development Index (HDI), a measure that reflects the life expectancy, education, and income of the population of each nation, countries were categorized as high, medium, or low HDI. This allowed comparisons among the HDI scores in the areas of education, professional practice, education, and practice competencies. Responding countries were 36.1% high HDI, 49.2% middle HDI, 8.2% low HDI, and 6.6% were unclassified. Dietetics was a nationally recognized profession in 81% of countries, with most having a professional association that represented dietitians. Clinical dietetics was the most frequently selected area of practice, followed by food service. Undergraduate academic programs in dietetics were available in 79% of countries and 49% offered graduate degrees. Most respondents rated competencies in clinical and community nutrition, along with competencies in professional practice, as important to their work. The results of this study can serve as a baseline as the profession evolves. Leaders in the dietetics profession can use these results to identify areas that need improvement. Collaboration with the United Nations family and sources that fund global initiatives can help in providing resources for the advancement of the profession. When the effectiveness of dietitians is improved, favorable changes in nutritional well-being on the global level can be expected.     

Satisfaction of recent University of British Columbia dietetics graduates with undergraduate education and current job

This study was designed to investigate the career status of recent University of British Columbia (UBC) dietetics graduates and their satisfaction with undergraduate education and current job. All graduates from the UBC Dietetics Program between 1978-1987, inclusive (n = 238), were mailed questionnaires. Information was sought regarding success in obtaining a dietetic internship, current employment status, job satisfaction, and satisfaction with undergraduate education. Questionnaires were returned by 67% (n = 130) of those who received them. Approximately 83% were eventually successful in obtaining an internship. Most respondents (68.5%) were employed as dietitian/nutritionists, and 69% of those who were employed worked full-time. Those who interned had significantly higher salaries than those who did not. A measure of overall job satisfaction revealed that 89.6% were satisfied to very satisfied with their present job, and scores on the Brayfield-Rothe Index of Job Satisfaction revealed no differences between those who did and did not intern. With regard to undergraduate education, respondents were most satisfied with library resources, class size and quality of teaching, and least satisfied with internship opportunities. Those who had interned were significantly more satisfied with their undergraduate education than were those who had not. We conclude that success in obtaining a dietetic internship affects salary and satisfaction with undergraduate education, but does not affect job satisfaction.     

Trying out the competency profile for entry-level nutrition/dietetics practice

The Ontario Regional Dietetic Internship Committee sponsored a workshop on "The Competency Based Profile", for Internship Directors and other dietitians involved with interns. The objectives of the workshop were: 1. to define the effects of implementation of some aspects of the competency profile into existing internship programs, 2. to exchange ideas regarding implementation, and 3. to give Internship Directors a further insight into the pros and cons of competency based education. Nine internship programs implemented some aspects of the profile. From one to seven dietetic interns and one to eleven dietitians were involved per program. Their findings were that the profile took on the average more time to complete than the regular CDA Dietetic Interns' Evaluation Forms. The profile could not be used as the sole evaluation tool. It was however an effective diagnostic tool. The rating scale is not well worded nor is its numerical system an effective way to evaluate dietetic interns. The competency profile is not suitable for all types of internship programs. Specialized internships have to expand on the profile to meet their own needs.