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PubMed2002

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.

Adult↗
PubMed1997

Dietetics and foodservice personnel are ready for team problem solving.

OBJECTIVE: To determine the readiness of dietetics and foodservice personnel for contributing to team problem solving. DESIGN: A descriptive, correlation study in which a five-part questionnaire was designed to collect data. SUBJECTS: Dietetics and foodservice personnel (n = 632) in eight hospital settings; 321 subjects (51%) volunteered to participate. STATISTICAL ANALYSES PERFORMED: Statistical data to summarize demographic information and two-way analysis of variance with a Scheffe post hoc analysis was used to investigate differences between dietetics and foodservice personnel on each of the subscales. RESULTS: In general, all respondents were somewhat oriented toward group problem solving and were confident in their problem-solving skills. Problem-solving expertise within the organization decreased for the respondents as the problem moved from their direct work areas to the organization level. Dietitians displayed higher self-efficacy in contributing to problem-solving teams than did foodservice personnel, indicating a 75% chance that they would contribute whereas all other respondents indicated a 50% chance of contributing. APPLICATIONS: The results of this study generate optimism for involving all dietetics and foodservice personnel in team problem solving. However, training activities are needed for both foodservice personnel and dietetics professionals.

Analysis of Variance↗
PubMed1997

Do you know what a dietetic technician can do? A focus on clinical technicians and their expanded roles and responsibilities.

Dietetic technicians, registered, play a key role in providing quality, cost-effective client care and foodservice management and are guided by the mission statement of the American Dietetic Association to promote optimal nutrition, health, and well-being. Many organizations use dietetic technicians to complete the screening and/or basic level assessments. The dietetic technician also can assist with patient monitoring and complete such tasks as calculating and documenting calorie counts, providing basic diet instruction, monitoring diet consumption and compliance, and determining tolerance of nutritional supplements. Since the last role delineation study was conducted, dietetic technicians have expanded into many different work settings, and practice roles have changed accordingly.

Allied Health Personnel↗
PubMed1999

The genetic revolution: change and challenge for the dietetics profession.

Advances in genetics are occurring at a pace that challenges our ability to understand and respond to the implications. Soon we will be able to define more precisely the molecular mechanisms underlying human health and disease; subdivide diseases and conditions (e.g., obesity) that are clinically indistinguishable into more distinct entities, thereby improving our ability to choose rational preventive and treatment measures; identify genotypic markers that predict metabolic responses to dietary interventions; stratify the population into groups at higher or lower risk for chronic diseases such as cancer, thus allowing dietary intervention to be appropriately targeted; and develop dietary recommendations that take into account genetically determined taste preferences. Dietetics leaders, teachers, practitioners, and researchers must act now to ensure that dietetics professionals are prepared for practice in this new era. In this article we introduce the Human Genome Project, review the fundamentals of molecular genetics, discuss genetics and disease risk, and define and give examples of diet-gene interactions. We also discuss issues relevant to dietary counseling of healthy people with genetic susceptibility to chronic disease. To foster the growth of knowledge regarding this new biology among dietitians, The American Dietetic Association should take the following steps: require course work on diet-gene interactions and include human genetics as a topic area on dietetic registration examinations, form a practice group on this topic, develop an Internet-based communication and information hub for dietetics professionals, sponsor a session on human genetics at annual meetings, begin a dialogue regarding a new practice specialty in diet and genetic counseling, and encourage a health care system in which personal counseling on diet-gene interactions is valued and reimbursed.

Diet↗
PubMedDate not supplied

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.

Cross-Sectional Studies↗
PubMed1985

Dietetic internship programs in Canada: a comparison between 1935 and 1985.

Dietetic internships for most Canadian university graduates in 1935 were only available in the United States. The first priority of the student training committee established by CDA in 1936 was to integrate the isolated attempts at student training in Canada and standardize the training programs. Fifteen hospitals were tentatively approved by the committee and a standard course outline developed. Internship program development in 1985 continues to emphasize the establishment of national standards and the administration and accreditation of dietetic programs. Many changes have occurred in dietetic training programs between 1935 and 1985 to meet the increasing demands on our profession. The founding members of our Association recognized the need to establish and maintain quality dietetic practice in 1935. Their foresight, determination, and search for excellence in those early years ensured the future of the dietetic profession in Canada.

Canada↗
PubMed2000

Nutrition and dietetics--neglected subjects in medical education.

A brief historical review of the development of nutrition and dietetics in the world is followed by concise description of the history of the discipline in Croatia after the foundation of the School of Medicine in Zagreb in 1919. As differentiated from the Schools of Medicine in Zagreb, Rijeka, Osijek and Split, the third, nutritional curriculum at the School of Food Science and Biotechnology has allocated as many as 280 theoretical and 110 practical periods in the form of seminars (15 periods) and practical exercise (95 periods) to nutrition and dietetics. The curriculum includes special course of lectures in dietetics, delivered by a physician specialized in the field. This is followed by the observation that none of the four Croatian Schools of Medicine in Zagreb, Rijeka, Osijek and Split has introduced systematic education in the field in either undergraduate or postgraduate curricula. There are only some sporadic related topics included in undergraduate and postgraduate studies. Thus, the paper points to the serious neglect of this important subject in the curricula of our medical schools, and present some ideas how to solve the problem in the nearest future. The possible organization of a special postgraduate study in nutrition and dietetics for physicians willing to devote themselves professionally to this field of medicine is strongly advocated, because modern nutritional practices and dietetics are likely to soon impose the need of such experts in every large hospital and clinical department.

Croatia↗
PubMed2004

Dietetic practice: the past, present and future.

The history of dietetics can be traced as far back as the writings of Homer, Plato and Hippocrates in ancient Greece. Although diet and nutrition continued to be judged important for health, dietetics did not progress much till the 19th century with the advances in chemistry. Early research focused focuses on vitamin deficiency diseases while later workers proposed daily requirements for protein, fat and carbohydrates. Dietetics as a profession was given a boost during the Second World War when its importance was recognized by the military. Today, professional dietetic associations can be found on every continent, and registered dietitians are involved in health promotion and treatment, and work alongside physicians. The growing need for dietetics professionals is driven by a growing public interest in nutrition and the potential of functional foods to prevent a variety of diet-related conditions.

Diet Therapy↗
PubMed1992

Use of mentor programs in dietetic education.

Persons entering their first professional position can benefit from the career guidance and role models provided by a mentor program. To determine whether mentor programs were being used in dietetic education programs, surveys were mailed to all 667 program directors listed in The American Dietetic Association (ADA) Directory of Dietetic Programs, 1990-1991. Of the 329 (49%) directors who responded, approximately half (47%) reported that their program had never considered including a mentor program. Nonetheless, directors from each of the six dietetic education options reported that their program included a mentor program. Respondents were generous with their comments. Directors identified limited time as the greatest obstacle for implementing mentor programs. Changes in curricular demands were also cited. Program directors indicated a need for more information and models of mentor programs. Networks linking the dietetic practice groups of the ADA Council on Practice and research on mentor programs' effect on retention of dietitians in professional practice are needed.

Data Collection↗
PubMed1991

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.

Dietetics↗
PubMed1990

Selection criteria for dietetic internship admission: what do internship directors consider most important?

A mail survey of the 97 dietetic internship directors listed in the 1989 Directory of Dietetic Programs determined the relative importance of criteria stated on the Dietetic Internship Application Form developed by The American Dietetic Association. A response rate of 91% was achieved. Results indicate that grade point average, success in professional and physiological/biological science courses, and former employment were the most important criteria to a majority of respondents. Extensive write-in comments indicated that a grade of C or less in upper-level professional, basic sciences, and management/business courses reduced the competitive edge; in some cases, a C excluded the student from an appointment. The importance of the application packet, application letter, and their neatness and accuracy was also stressed. Directors desired letters of reference that provided insight about the student not readily available in the application information, e.g., flexibility and dependability. In summary, directors are looking for an overall academically strong student with good references and some work experience (either paid or volunteer) that seems to fit with a career choice in dietetics.

Attitude of Health Personnel↗
PubMed1989

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)

Administrative Personnel↗
PubMed1987

Expanding undergraduate dietetic education through a health promotion internship program.

The Lifestyle Assistant Program is a health promotion internship offered by the University of Wisconsin-Stevens Point Health Service. Students majoring in health-related disciplines (e.g., dietetics) gain skills in promoting the six dimensions of wellness: social, occupational, spiritual, physical, intellectual, and emotional. Thirteen competencies provide the basis for training Lifestyle Assistants, who develop, market, present, and evaluate wellness sessions for the university and residential communities. Assistants earn academic credit or a wage. Of particular benefit to assistants majoring in dietetics are studying and operating a self-testing physical assessment unit, which approximates body composition, cardiovascular endurance, muscular strength, and flexibility; using a health hazard appraisal; assisting the University's Nutrition Task Force with its education campaign in the campus cafeterias; and presenting programs on popular nutrition topics (e.g., the athlete's diet). Program evaluation reveals that 84% of participants in programs conducted by assistants gained information of personal benefit. The Lifestyle Assistant competencies support The American Dietetic Association Plan IV minimum competencies in such areas as communication and education. The Lifestyle Assistant experience is in accordance with The American Dietetic Association's Dietetic Manpower Study recommendations: to provide student learning experiences in wellness programs and fitness settings.

Dietetics↗
PubMed1983

Psychological and dietetic counselling combined in the treatment of obesity: a comparative study in a hospital outpatient clinic.

This study examined the effectiveness of combining behaviour modification with dietetic counselling in a hospital outpatient clinic. Thirty-six females with an obesity index over 25 were placed in one of three 16-week treatment conditions: (1) individual dietetic counselling, (2) group dietetic counselling, (3) group dietetic counselling with behaviour modification. Median end of treatment weight losses were 8.3, 4.6 and 6.9 kg respectively. At one year follow-up patients in Gp 2 tended to have regained their weight while patients in Gps 1 and 3 were equally successful in maintaining weight loss. However, trends towards lower rates of attrition, slower rates of decay of treatment effects and a more economical use of professional time favoured the dietetic behavioural group condition as a treatment choice. In view of the successful use of behavioural techniques by a variety of professions their wider employment by dietitians is advocated.

Adolescent↗
PubMed1981

The A.D.A. role delineation for the field of clinical dietetics: 2. Methodology and summary of results.

Drawing upon the experience of previous contractors with the Division of Associated Health Professions, A.D.A. project staff and consultants designed and implemented a study methodology suited to the unique characteristics of the profession. To delineate the "actual" entry role of clinical dietetics and develop an informational base for further research, project staff compiled qualitative data which were subsequently analyzed by the Working Committee, using structured group decision-making processes. Next, a survey was administered to dietetic and other health professionals to form a data base of opinion on the degree to which clinical dietetic personnel should be accountable for the performance of specific responsibilities. Using group decision-making processes, the "appropriate" entry role responsibilities and supporting skills and knowledge for clinical dietetics were delineated by filtering data through the professional judgment and expertise of the Working Committee. Practice levels were identified, and skill and knowledge statements were weighted for degree of importance, again using structured group decision-making techniques. Two practice levels of the entry role were delineated: clinical dietitian and clinical dietetic technician. Through a process involving the Advisory and the Working Committees, project documents were refined for implementation by the profession.

Clinical Competence↗
PubMed1976

The dynamics of dietetics.

The forces which have and are producing change in dietetics are recapitulated, as are developments in the profession which have evolved since 1972 when the Study Commission on Dietetics made its report. The coordinated undergraduate program in dietetics has gained much ground; in 1972, there were but seven such programs. Today there are forty-three. More than three hundred traineeships are currently preparing over five hundred trainees to take their places in the profession. Another facet of training involves programs for dietetic technicians and dietetic assistants, designed to open up the career ladder concept. Continuing education is of prime importance for those beyond the entry-level of competence. The dietitian's first responsibility is to society, preceding that for the profession-as has been plainly indicated in a number of A.D.A. Position Papers and the emphasis of the Association in its legislative thrust on the value of nutrition education in preventive health care. Concern of the Association about the competency of practicing dietitians has also been reflected in the early appointment of a Committee on Professional Standards Review. The Association, as a member of the National Nutrition Consortium, is an advocate for a "National Nutrition Policy" and must continue to work for recognition that nutritional care is basic to comprehensive health care.

Accreditation↗
PubMed2003

Evaluation of dietetic intervention in children with medulloblastoma or supratentorial primitive neuroectodermal tumors.

BACKGROUND: Malnutrition is a common complication of cancer treatment; it can affect energy levels and, as a consequence, quality of life. The goal of the current study was to evaluate the effect of dietetic intervention in a cohort of children treated for medulloblastoma and supratentorial primitive neuroectodermal tumors (PNET) over a 10-year period. METHODS: A retrospective chart review (1992-2002) of newly diagnosed cases of medulloblastoma/supratentorial PNET was performed. Hospital records were reviewed for data, including demographic characteristics, patient heights and weights, and information on treatment modalities and the use of dietetic intervention. Percent changes in body weight were calculated at time points associated with particular stages of treatment or dietetic intervention. RESULTS: One hundred three of 112 cases were evaluable. Treatment methods included surgery only (7.8%), surgery + radiotherapy (16.5%), surgery + chemotherapy (14.5%), and surgery + radiotherapy + chemotherapy (61.2%). There was no significant change in patient weight due to surgery (median change in body weight [MCBW], -0.35%) or radiotherapy (MCBW, -0.78%). In contrast, children experienced significant weight loss (MCBW, -4.35%; P < 0.0001) 3 months after starting chemotherapy. A dietician saw 53 of the 103 children in the study cohort. There were 84 dietetic interventions (oral, 36%; parenteral, 27%; enteral, 37%) among these 53 patients. Oral diets did not result in weight gain. Parenteral nutrition was associated with significant weight gain at 1 month (MCBW, +2.7%; P = 0.03), but not at 3 months. The use of enteral feeds resulted in significant weight gain at 1 month (MCBW, +4.8%; P = 0.006) and at 3 months (MCBW, +11.8%; P < 0.0001). CONCLUSIONS: Current multimodality treatment of intracranial PNET results in significant nutritional morbidity, primarily due to the use of intensive chemotherapy regimens. Dietetic input for pediatric patients with medulloblastoma/PNET is essential, and the implementation of enteral feeding in these children can help to reverse their nutritional morbidity.

Adolescent↗
PubMed1999

Provision of dietetic care in children on chronic peritoneal dialysis.

OBJECTIVE: To estimate the provision of dietetic care necessary to manage and support children receiving chronic peritoneal dialysis (CPD) with/without nutritional support via a gastrostomy button (GB) and their families. DESIGN: Three-year prospective, longitudinal study documenting dietetic contacts (direct: inpatient/outpatient, telephone, home, school, and family practitioner visits; and indirect: with other health professionals). SETTING: Regional Pediatric Renal Unit. PARTICIPANTS: Thirteen children (7 male; 5 <5 yrs of age) commenced CPD at a mean age of 7.7 years (range, 0.2 to 8.5 years). Eight children received tube feeding (7 GB, 1 nasogastric [NG]) in combination with CPD at a mean age of 4.3 years (range, 0.2 to 8.2 years). MAIN OUTCOME MEASURES: Quantitative data regarding dietetic contacts and growth parameters. RESULTS: Seven hundred eighty-one dietetic contacts were recorded during 182 patient months of observation, with a mean of 5.9 (standard deviation [SD] 1.9) contacts per patient, per month in children <5 years of age, compared with 3.1 (SD 1.6) contacts in children >5 years of age. Eighty-two percent of contacts were with children receiving nutritional support via a GB. Telephone contact accounted for 41% of all contacts in the less than 5 years of age group, compared with 7% in children greater than 5 years of age. Mean standard deviation scores (SDS) for height and weight at the start of the study were -1.2 and -1.32, and at the end were -1.14 and -0. 73. Body mass index (BMI) SDS significantly improved from -0.91 to 0. 17 (P = 0.03). CONCLUSION: This study illustrates the number and nature of dietetic contacts that we felt were required to support children and families on CPD. Attempts to achieve adequate nutritional intakes for growth require frequent adjustments of nutritional prescriptions, particularly in preschool children.

Adolescent↗