Dietetic Program Curricula: Room for Growth? --A Dietetic Intern Perspective

An assumption can be made that most individuals who enter a dietetic program or a Didactic Program in Dietetics (DPD) primarily judge the program by the end result and not by the courses required to complete the degree. It can also be assumed that many students of the program won’t realize their education may be missing some pieces or wish a topic was covered more comprehensively until they are either in their internship or landed their first job.


It can be argued that it is impossible for a program to provide sufficient preparation for every position that exists within the dietetic profession, but each program should minimally reflect the evolution of the profession, ensuring that the natural shifts that occur with time and change are included. Naturally, some components of dietetics remain universal to the field and should continue to be addressed accordingly in the coursework, while the focus of some courses seem a bit outdated and not as reflective of even the RD exam (based on domain percentages tested), let alone the representation of the professional field. It could be beneficial to new dietitians if these courses were condensed and/or covered within other courses so that room could be made for more relevant study.


Which courses could benefit from a slight adjustment?


Macronutrients and Micronutrients

My program offered one thorough semester of each. I cannot downplay how critical these courses are. Lengthening each course to cover two semesters so that sufficient time is spent understanding the pathways and impact of these nutrients, as they are literally the foundation of this profession, is integral. In a 2020 study of dietetics education, it is noted 100% of participants (all practicing dietitians) strongly agree that “nutrients” and “nutrient metabolism” are key to nutrition and dietetics education.1 Extending the time spent with each nutrient could improve overall understanding, diminishing the potential for students to simply memorize content for tests, and ultimately allow for greater retention of information.


Medical Nutrition Therapy

Invaluable. My program provided a progressive series of three. The last course also offered a single simulation opportunity. This experience could be even more useful if integrated more frequently into the coursework and if the practice directly connected to the course’s progression of content. The transition from learning content in courses to real life application that requires hands-on contact with another human being can be difficult for interns and new dietitians. Recurrent simulation experiences can ease this transition. It can provide opportunity to improve the Nutrition Focused Physical Exam (NFPE) skills as well as build confidence when conducting a physical exam, all in a safe learning space.2


Which courses may not currently be required in every program but, arguably, should be?


Disordered Eating

After completing my DPD program, I elected to take a master’s level Disordered Eating course (one that was only offered post-baccalaureate when I attended). To say that this course should be required within every single (undergraduate) dietetic program, is an understatement. Future dietitians are potentially graduating with a very limited understanding of disordered eating. It is clear students graduate understanding weight loss and the intricacies of “healthy” eating, but are they able to effectively work with individuals whose relationships with food/eating dominates every aspect of their life, and overall, is negatively impacting their health?


Prevalence, screening, and nutrition counseling for individuals with disordered eating behaviors is lightly touched on in various courses, and yet there are very few areas within the dietetic profession where a dietitian will not encounter individuals with disordered eating behaviors. How detailed was your program’s curricula in this area? Along with specific disordered eating coursework incorporating a companion concept, a weight neutral approach to health, could be embedded into an entire program’s curricula.


Non-Diet Weight Neutral Approach (Health at Every Size)

Traditional methods of weight management often target excess weight loss through various forms of restrictive behaviors even though these approaches are typically ineffective in the long-term.3 How was health and weight loss depicted in your program? What about obesity and obesity as it correlates with chronic disease? Curriculum that incorporates non-diet, weight neutral approaches to healthy living profoundly contrasts the often-automated stigma that is offered for those living in larger bodies. The Non-Diet Weight Neutral (NDWN) approach and Health at Every Size (HAES) approach focus on health versus weight loss, self-acceptance and wellbeing, and movement promotion over restrictive behaviors. Not only have these approaches shown both short and long-term effects on “improving participants health markers”, but they also influence overall psychological well-being.4



Food Systems and Sustainability

There are “increasing rates of hunger and food insecurity, climate fluctuations leading to drought and floods in agricultural lands, and continued degradation of our lands, water, and mineral resources required to produce food”.5 Just as our food system impacts our planet, and is conversely impacted by environmental changes, it directly shapes our diets, health, and the nutritional bioavailability of the foods we depend upon.6 How can dietitians address health and “healthy” eating without first attending to the lack of food access so many people in this country (and around the world) face?


A 2011 survey of practicing dietitians indicated the need to include food systems and sustainability curriculum, specifically “community food security”, “contamination and food safety”, and “seasonally available foods” within didactic programs. Community Nutrition courses are those most likely to include these concepts, but time within curriculum and a lack of guidance on student activities, projects, and readings are the biggest obstacles to including comprehensive coverage of these issues.7


In 2020 a dietetics education study noted between 90% and 94% of participants (all practicing dietitians) strongly agree that including food systems education is key for nutrition and dietetics education and 85% to 89% strongly agree sustainability content is also crucial.1


Providing food systems and sustainability curricula highlights food insecurity and promotes empathy. Empathy is the “ability to experience another person’s emotional state, understand their viewpoint, and be able to communicate their perspective”.8 Being empathetic toward the struggles of individuals in a community or with clients as a health practitioner can build rapport and trust which can lead to improved health outcomes and overall well-being.


New and practicing dietitians must not only be aware but be advocates for change. We cannot ignore the reasons why/how food insecurity exists, just as we can’t separate how impactful food systems is on our profession. Access to healthy foods (or food in general) is directly connected to the professional dietetic positions within public health, school food service, and clinical health settings. It would be both negligent and detrimental to those receiving information if the service is provided under a goal of health improvement without adequately addressing these other facets.


Just like within any other profession, change takes time; and unfortunately, those foundational changes take even longer to reach the coursework students seeking to enter a profession are provided. Required curricula must remain fluid to best reflect the workings of the profession as change within the field is certain.



Danielle Anderson M.Ed., NDTR

5/7/21

-Written during enrichment rotation with MAK Nutrition Services



References

1. Tweedie, Judith, et al. “Key Concepts for Dietetic Curriculum: An Observational Study of Australian Dietitians' Perceptions.” Nutrition & Dietetics, 2021, doi:10.1111/1747-0080.12654.

2. Tyler, Caitlin. “Incorporating Simulations of the Nutrition-Focused Physical Exam into Graduate-Level Dietetics Curriculum.” University of Kansas, Proquest Dissertations Publishing, 217AD, pp. 1–52.

3. Huebner, Grace E., et al. “Nondiet Weight-Neutral Curricula Limited in Current Accredited US Dietetic Programs.” Journal of Nutrition Education and Behavior, 2021, doi:10.1016/j.jneb.2020.12.005.

4. Clifford, Dawn, et al. “Impact of Non-Diet Approaches on Attitudes, Behaviors, and Health Outcomes: A Systematic Review.” Journal of Nutrition Education and Behavior, vol. 47, no. 2, 2015, doi:10.1016/j.jneb.2014.12.002.

5. Harmon, Alison, et al. “Teaching Food System Sustainability in Dietetic Programs: Need, Conceptualization, and Practical Approaches.” Journal of Hunger & Environmental Nutrition, vol. 6, no. 1, 2011, pp. 114–124., doi:10.1080/19320248.2011.554272.

6. Nordin, Stacia, et al. “Nutrition Education for Sustainable Global Food Systems.” Journal of Nutrition Education and Behavior, vol. 52, no. 3, 2020, p. 213., doi:10.1016/j.jneb.2020.01.010.

7. Harmon, A.H. “Teaching on the Food System and Sustainability in the Dietetic Curriculum: A Survey of Educators.” Journal of the American Dietetic Association, vol. 107, no. 8, 2007, doi:10.1016/j.jada.2007.05.138.

8. Harmon, Alison, et al. “Food Insecurity Experience: Building Empathy in Future Food and Nutrition Professionals.” Journal of Nutrition Education and Behavior, vol. 49, no. 3, 2017, doi:10.1016/j.jneb.2016.10.023.



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