Evaluation tools for undergraduate program planning in times of financial austerity

This article describes the administration and outcome of two evaluation tools developed by faculty of the dietetic program for ongoing assessment of a Plan IV dietetic education program over a 4-year period. Interns and internship directors were asked to evaluate the level of skills and knowledge base of interns compared with their internship classmates. Interns were also asked to rate the effectiveness of undergraduate course assignments and activities for internship preparation. As a result of the surveys, the home economics core course work was deleted, credits were shifted from food science to nutrient metabolism courses, and credits in clinical nutrition were increased. Projects in clinical nutrition and food systems management were modified. The surveys justified program requirements and utilization of resources, and provided an additional, effective measure of faculty competence.     

Model for multicultural nutrition counseling competencies

A model for multicultural nutrition counseling competencies for registered dietitians was developed and tested. Six hundred four registered dietitians who were members of The American Dietetic Association Public Health Nutrition Practice Group or directors of dietetic internships and didactic programs in dietetics were selected by a stratified random sample method and were mailed a survey. Respondents rated each of 46 competencies using a Likert scale to delineate how essential each competency will be for entry-level dietitians in the next 10 years. Of the 60% who responded (n=363), 94.4% met the study selection criteria. Most were white (85.7%), spoke English as their primary language (96.8%), and had a master's degree (64.4%). Many (37.9%) worked in community/public health facilities or organizations, and 50.4% provided nutrition counseling or education to clients culturally different from themselves. Exploratory principal components analysis extracted 3 factors with 28 competencies loading on them: multicultural nutrition counseling skills, multicultural awareness, and multicultural food and nutrition knowledge. Subjects responded similarly whether or not they provided nutrition counseling to culturally different clients. Secondary analysis revealed no significant interaction or differences between how bilingual dietitians and those of color scored items in the 3 factors. The resulting model is a guideline that can be used by educators to enhance dietetics education and training and by public health nutritionists as a basis for self-evaluation and selection of continuing education opportunities to enhance their multicultural nutrition counseling competence.     

Education, research, and practice: bridging the gap

The purpose of this study was to identify the research activities that were part of dietetic internship and coordinated undergraduate programs. Data about required research courses, research-related experiences, curriculum competencies, student publications, and faculty needs were obtained from 79 dietetic internship and 46 coordinated undergraduate program directors. Research courses were required in 60% of the programs and most often included basic statistics and review of the literature. Attendance at research conferences and observation of research dietitians were the most frequent learning experience activities. A wide variety of research projects were required by 71% of the programs, but there were few student opportunities to participate in faculty-sponsored research. The ability to evaluate literature critically, knowledge of research concepts, and application of research findings to dietetic practice were the most frequently cited competency statements. Less than 2% of graduates in a 3-year period had published in professional journals. Faculty members believed they needed more time, money, educational materials, professional development, and access to research facilities to improve the research component of the program. These findings suggest that research competencies may need to be prioritized differently in view of changing needs in dietetic practice.     

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.     

Graduates of internships and coordinated undergraduate programs--do differences exist?

Two principal routes have existed for several years for gaining credentials for dietetic practice, the dietetic internship and the coordinated program. However, comparative evaluations of the effectiveness of these programs in preparing entry-level practitioners have been limited. In this study, adequacy of educational preparation and performance of dietetic internship and coordinated program graduates was assessed at entry level and after one year of practice, using graduates' self-ratings and supervisors' evaluations. The majority of graduates who were employed in dietetic practice held clinical positions in hospitals or university medical centers. Educational preparation and level of performance of all graduates were considered to be adequate, indicating that both types of programs are preparing knowledgeable and competent entry-level practitioners. Although differences on competency measures were not reflected at entry level, intern graduates scored significantly higher than graduates of coordinated programs on administrative and clinical competencies after one year of practice. Also, at entry level and after one year, those completing internships were rated higher on two performance style measures: initiative/self-assurance and dependability. In general, supervisors' ratings tended to be higher than graduates' self-ratings.     

Cooking skills are important competencies for promoting healthy eating in an urban Indigenous health service

Aim: A recent article in this journal asked whether cooking should be a dietetic competency and recommended finding dietitians’ views on the use of cooking skills interventions as nutrition education. This article presents views about the value of cooking skills in the work of nutrition professionals and students working in an urban Indigenous health service. Methods: We reflect on our experience facilitating a series of practical cooking workshops in adult Aboriginal and Torres Strait Islander groups and the importance of cooking skills for professionals promoting nutrition in community contexts. Results: Cooking skills were essential for facilitating practical workshops to promote healthy cooking and eating among urban community groups. The workshops provided participants with new cooking ideas, opportunities to cook new recipes and some unfamiliar ingredients as well as learning new cooking skills. These enabled participants to be more confident preparing healthy meals at home. Cooking skills enhanced the processes of both effective community engagement and nutrition promotion. Conclusion: Cooking interventions make an important contribution to promoting nutrition in urban Indigenous contexts and cooking skills are therefore important competencies for nutrition and dietetic professionals delivering practical community nutrition programs.     

Dietetic specialization: opinions of directors of departments of dietetics

The need for specialists in dietetic practice was studied by surveying a stratified, random sample of 750 directors of departments of dietetics from nonfederal, general medical-surgical hospitals with more than 75 beds. The response rate was 72%. The majority of respondents were directors who considered themselves generalists. Five demographic variables used in data analysis were hospital size, education level, registration status, years of experience, and perception of practice as generalist or specialist. Student's t-test and analysis of variance were the principal methods of statistical analysis. Results indicated that respondents supported dietetic specialization; however, they emphasized the value of undergraduate generalist preparation as enhancing job performance and preventing fragmentation of the profession. Respondents indicated that specialization should follow professional work experience and additional education. Respondents stressed that The American Dietetic Association should be responsible for determining the process of dietetic specialization. Education level was the variable most likely to affect response. Respondents with education beyond the baccalaureate level were more likely than those with only a bachelor's degree to agree that specialization should occur after professional experience and at the graduate level.     

Selection criteria for approved preprofessional practice programs: are they different from those for dietetic internships?

Using a mailed questionnaire, we surveyed the directors of 41 approved preprofessional practice programs (AP4) listed in the Directory of Dietetic Programs 1990 and nine programs approved by The American Dietetic Association's Council on Education in December 1989 to determine the relative importance of admission criteria used to select students for AP4s. We compared the results of this study with those of an earlier survey of dietetic internship directors. The AP4 and dietetic internship directors gave significantly different importance ratings to elective courses in professional sciences and courses in the biological/physical sciences. Unlike dietetic internship directors, AP4 directors rated Graduate Record Examination (GRE) score highest (1.4 +/- 1.7 on a 10-point scale). AP4 directors' rating of grade point average (1.8 +/- 1.3) and professional courses (1.9 +/- 1.2) was similar to the internship directors' rating of these criteria (1.7 +/- 0.9 and 1.7 +/- 1.0, respectively). Results indicate that AP4 and internship directors seek similar qualities in students, but that GRE score is more important to AP4 directors. The AP4 directors' emphasis on GRE score may be explained, in part, by the fact that 76% (38 of 50) of these programs are affiliated with a university program, and of those 38 programs, 29 (88%) require graduate credit as a component of the AP4. These data are important to Plan IV/V faculty advisers because students may have misconceptions about differences in AP4 and internship selection criteria.     

General competencies of problem-based learning (PBL) and non-PBL graduates

INTRODUCTION: Junior doctors have reported shortcomings in their general competencies, such as organisational skills and teamwork. We explored graduates' perceptions of how well their training had prepared them for medical practice and in general competencies in particular. We compared the opinions of graduates from problem-based learning (PBL) and non-PBL schools, because PBL is supposed to enhance general competencies. METHOD: We analysed the responses of 1159 graduates from 1 PBL and 4 non-PBL schools to a questionnaire survey administered 18 months after graduation. RESULTS: Compared with their non-PBL colleagues, the PBL graduates gave higher ratings for the connection between school and work, their medical training and preparation for practice. According to the graduates, the most frequently used competencies with sufficient coverage during medical training were expert knowledge, profession-specific skills and communication skills. The majority of the PBL graduates, but less than half of the non-PBL graduates, indicated that communication skills had been covered sufficiently. All the graduates called for more curriculum attention on working with computers, planning and organisation, and leadership skills. More PBL graduates than non-PBL graduates indicated that they had learned profession-specific methods, communication skills and teamwork in medical school. DISCUSSION: Overall, the graduates appeared to be satisfied with their knowledge and skills. The results suggest that the PBL school provided better preparation with respect to several of the competencies. However, both PBL and non-PBL graduates identified deficits in their general competencies, such as working with computers and planning and organising work. These competencies should feature more prominently in undergraduate medical education.     

Use and barriers to use of laboratory data by clinical dietitians

The results of this study reveal two general areas of concern for clinical dietitians in the use of laboratory data--their lack of confidence in their own interpretive skills and the perceived resistance of physicians. Although clinical dietitians receive theoretical and applied training on the use of laboratory values in their undergraduate education and dietetic internship, clinical managers should be aware that they need support and continuing education to use their laboratory assessment skills to the fullest. Also, dietitians should demonstrate more clearly to physicians their knowledge, skill, and needs in this area. They should initiate and continue dialogue about the importance of laboratory analysis to nutrition care and improved patient outcome. Evidence-based data and clear documentation of improved medical outcomes should help overcome barriers to use of laboratory data by clinical dietitians.     

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.     

Coordination of classroom and clinical experience.

Clinical experience, providing opportunity to apply concepts and theories presented in the classroom, is essential in the education of a dietetic practitioner--whether it be as assistant, technician, or professional. Coordination of theory and practice is needed to permit students to acquire the knowledge, attitudes, and skills necessary for competent practice. Accountable program planners and instructors are responsible for presenting curricula designed to provide such coordinated classroom and clinical experiences in a relevant, holistic approach to the education of future dietetic practitioners.     

How can nutrition education contribute to competency-based resident evaluation?

The Curriculum Committee of the Nutrition Academic Award (NAA) has created a consensus document of knowledge, skills, and attitude learning objectives for medical nutrition education. To evaluate the impact of nutrition education in residency training, it is necessary to specify the goals and objectives of that education in terms of specific learner outcomes. To make the NAA objectives more user friendly for graduate medical education faculty, they must be translated into measurable competencies. The Accreditation Council for Graduate Medical Education has proposed a schema for organizing resident competencies. This article illustrates one way that the NAA curriculum objectives can be translated into specific competencies to demonstrate medical knowledge, patient care, practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice.     

Prediction of graduate dietetic internship appointments in Canada

A statistical model of dietetic intern selection was developed from a profile of selection criteria that was obtained in a 1988 survey of Canadian graduate dietetic internship directors. The model was composed of four clusters of variables that resulted from the most frequently used selection criteria: academic performance, work experience, communication skills, and extracurricular activities. Data from a convenience sample of 39 dietetic intern applicants were analyzed, using principal components analysis and discriminant analysis, to test the model's power to predict success in obtaining an internship appointment. In descending order, the criteria with the greatest predictive powers were: academic performance; extracurricular activities; and supervisory, teaching, or instructing types of work experience. The model accounted for 41% of the differences between those who were successful and those who were not successful in obtaining internship appointments in 1989 and correctly classified 30 of 39 subjects. These results provide baseline data on the predictive power of some criteria used for selecting dietetic interns. These findings suggest the need for a replication study with a randomized national sample to crossvalidate the results obtained in this exploratory research.     

Enhancing didactic education through participation in a clinical research project.

The purpose of this study was to assess self-evaluation of knowledge and skills (e.g., counseling, education, interviewing, and assessment skills) of students participating as research assistants. Fifteen students enrolled in the Dietetics Program (n = 10) or the Graduate Program in Nutrition (n = 5) were recruited as research assistants via flyers and announcements in nutrition courses. These students assisted faculty researchers with their clinical study called "Weight Loss Effects on Bone Mass in Adolescent Females." The clinical study included a comprehensive 6-month weight-loss program. Surveys asking students to evaluate their experience as research assistants were mailed with a self-addressed, stamped envelope to all 15 student research assistants, followed by a reminder telephone call. Thirteen surveys (87%) were returned. On a Likert scale (1 = poor, 5 = excellent) student research assistants scored 63% of the knowledge-based and skill-based requirements of their research participation as "good" (mean score > or = 4.0) and 27% as "adequate" (4.0 > or = mean > or = 3.5). Open-ended questions reported the research experience to be beneficial in developing knowledge and skills and in identifying knowledge deficits (e.g., behavior modification). According to our findings, it seems that participation in clinical research enhances students' knowledge and skills and, thus, is valuable in preparing dietetics students for future practice.     

Assessment of student selection practices and beliefs in dietetic internship programs

With declining college enrollment, the health professions, including dietetics, are recognizing a need to assess and monitor student selection more closely. In this survey of 102 dietetic internship programs, program directors and a sample of their faculty members were asked to describe their current selection practices and to identify the beliefs they hold about the information obtained from various components of their procedures. Differences in beliefs between program directors and other faculty members were compared by t-test analysis. The five major categories of internship selection procedures are presented with information items faculty members believe are derived from each category, and the results are compared with those of previous surveys of dietetic selection practices. Major findings are that the intern selection process has changed significantly since 1978, with greater emphasis on work experience and extracurricular activities; the number of applicants per position has doubled despite a doubling of dietetic internship programs; and program directors and faculty members agree on the major selection practices but not on the information obtained from a given category. In the discussion, the findings are evaluated against a broad background of health profession education literature; implications are raised for intern selection committees and for the applicant.