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

Integrating Systems Thinking in Nutrition and Dietetics Education

INTRODUCTION

Integrating systems thinking, which emphasizes recognizing interconnections, gaining diverse perspectives and considering the big picture, can enhance curricula and better prepare practitioners. Despite its benefit and growing support, systems thinking is not yet a required part of dietetics accreditation or entry-level practice. This qualitative study sought to understand educators' views on incorporating systems thinking into nutrition and dietetics education.

METHODS

Thirteen Registered Dietitian Nutritionists from various US census regions and accredited program types were recruited. Semi-structured interviews were audio-recorded and transcribed verbatim. Grounded theory methodology and iterative coding analysis were used to analyse the transcriptions in Excel.

RESULTS

Three interrelated themes emerged from educator perspectives: (1) individual characteristics (personal attributes; multi-, inter- and transdisciplinary experiences; perspective seeking; relationship building), (2) nutrition and dietetics education (training, resources, accreditation requirements, value awareness) and (3) the dietetics profession (organizational culture, education and practice integration, continuing education, professional guidance).

CONCLUSIONS

Integrating systems thinking into nutrition and dietetics education can be facilitated across three levels: individual, education and the profession through training, resources, accreditation competencies and awareness. However, implementation requires fostering a cultural shift within the profession and overcoming resistance to change.

Workforce development in private practice dietetics: experiences and perceptions of experienced practitioners

BACKGROUND

Changes in Australian health policies and public funding models have increased the demand for private dietetics services over the past two decades. Limited available workforce data indicate that over half of the Australian dietetics workforce works in private practice at some level, with approximately 30%-50% of dietitians now entering private practice as new graduates. These changes in the sector have implications for dietetics workforce development. The present study aimed to explore private practice dietitians' perceptions and experiences about workforce development needed to successfully work as a private practice dietitian.

METHODS

Australian private practice dietitians were purposively sampled for participation in semistructured interviews on their experiences of, and perceptions about, workforce development needs for successful private practice. Data were analysed using qualitative thematic analysis methods.

RESULTS

Sixteen dietitians participated. Twenty-seven themes emerged across seven constructs spanning pathways to practice, the work of private practitioners, workforce preparation, competency development, placements, competency requirements and challenges.

CONCLUSIONS

Experienced private practice dietitians offer critical insights into the workforce development needs and challenges of the sector. Study participants indicated that their preparation for private practice was suboptimal and they have endured many challenges during their careers. This study highlights the need for a strategic approach to workforce development for private practice, including further research into the preparation and needs of this evolving area.

Enhancing Adaptability: Exploring Structural Empowerment and Systems Thinking Among State Governmental Public Health Nutritionists

This study explored how structural empowerment and systems thinking enabled public health nutritionists to adapt to complex environments. Interviews with 14 dietitian-prepared nutritionists from state governmental public health agencies elucidated 3 key themes: leveraging relationships was essential to exercising structural empowerment and systems thinking; accessing resources and support were priorities in supporting public health nutrition initiatives; and addressing gaps in formal training, specific to systems thinking, enabled adaptability to work in public health settings. The findings highlight the need for broader examinations into strengthening access to organizational power structures; integrating systems thinking into public health operations; and sustaining professional development for the public health workforce, especially with limited resources. Enhancing access to organizational power structures and applying systems thinking can empower the public health workforce to better adapt to challenges by building relationships, accessing resources and support, and making informed decisions that positively impact population health.

The intersection of systems thinking and structural empowerment in the work of public health dietitians

BACKGROUND

Public health dietitians navigate complex professional landscapes amid dwindling resources, organisational disruptions and limited advancement opportunities. Cultivating systems thinking and structural empowerment competencies may enable this workforce to address multifaceted public health challenges more effectively. This study explored the extent to which public health dietitians apply systems thinking and perceive access to structural empowerment and the relationship between these constructs.

METHODS

A quantitative online survey incorporating the systems thinking scale (STS) and conditions for work effectiveness questionnaire-II (CWEQ-II) was conducted among US public health dietitians who worked in governmental public health. Data were collected from September 2022 to October 2022. Descriptive and inferential statistical analyses were conducted.

RESULTS

Among 216 respondents, 98% demonstrated moderate-to-high systems thinking competency (mean STS score = 60.3 ± 8.74, range 28-78). Over 88% reported moderate-to-high perceived structural empowerment (mean CWEQ-II score = 18.3 ± 0.96, range 8-29). Higher systems thinking scores were associated with greater decision-making authority (p = 0.01) but not budget oversight. Higher structural empowerment scores correlated with increased job responsibilities and decision-making authority (p < 0.001). A significant positive correlation existed between systems thinking and structural empowerment (r = 0.24, p < 0.001). Public health dietitians exhibited substantial systems thinking capabilities and perceived access to organisational power structures.

CONCLUSIONS

This study offers baseline understanding of systems thinking and structural empowerment among public health dietitians. The positive interplay between these constructs underscores their potential to drive systems-level change and influence population health outcomes. Integrating systems thinking and structural empowerment into dietetic education and professional development may enhance the workforce's preparedness for navigating complexities.

Preprofessional Identity of Nutrition and Dietetics Students in Australia

OBJECTIVE

This study aimed to explore the preprofessional identity of undergraduate nutrition and dietetic students to guide curriculum development to better support the expectations of students and promote career readiness in a changing profession.

DESIGN

Qualitative focus group discussions in March, 2021.

SETTING

An Australian university.

PARTICIPANTS

First-year students enrolled in the Bachelor of Nutrition (n = 50) or Bachelor of Dietetics (n = 58) at the University of the Sunshine Coast.

MAIN OUTCOME MEASURES

Student sociodemographics, motivations for and influences on career choice and preprofessional identity, expectations of professional competency and practice, degree, and career expectations.

ANALYSIS

Descriptive statistics were conducted, and focus group discussions were analyzed using the Framework Approach.

RESULTS

Motivations and skills were consistent across both cohorts, centering on an interest in nutrition and respectful, professional conduct and communication. Expectations were similar across both degrees, with a focus on placement, real-world learning experiences, and staff support. Career expectations for both cohorts included business ownership.

CONCLUSIONS AND IMPLICATIONS

This research provided an understanding of students' preprofessional identity, which was similar for both nutrition and dietetics students. Motivations identified in this research can be used to inform activities across nutrition and dietetic programs that support career readiness.

Encouraging entrepreneurship in dietetics: A qualitative exploration of the experiences of new graduate dietitians participating in an entrepreneurship mentoring circle

AIMS

Healthcare needs of the Australian population are changing, providing an opportunity for dietitians to embrace innovation and entrepreneurship to meet evolving demands. This study explored the expectations and experiences of participants in a 12-month mentoring circle designed to provide entrepreneurship learning and formal mentoring for the Provisional Accredited Practising Dietitians Program.

METHODS

A qualitative study design was employed. New graduate dietitians (<2 years) participating in the Entrepreneurial Dietetics Mentoring Circle in 2019, 2020 or 2021 were invited to participate. Baseline demographic and employment data were collected via survey. Semi-structured interviews were conducted before mentoring circle session 1 (baseline) and after the final session (completion), exploring insights into participant expectations and experiences in entrepreneurship. Thematic analysis, using methods outlined by Braun and Clark, was conducted to identify themes and subthemes.

RESULTS

Twenty-eight dietitians participated (85% of mentees). Participants were mostly female (89%), less than 12 months post-graduation (75%), registered as Provisional Accredited Practising Dietitians (82%) and employed at least part-time (55%). Forty five interviews were conducted (28 baseline, 18 completion). Themes developed were: (1) entrepreneurial career path as a deliberate choice; (2) the value of being prepared for entrepreneurial careers; and (3) the importance of networks to support entrepreneurship.

CONCLUSION

The mentoring circle at this single university was seen by participants as supporting their transition into entrepreneurial careers, while meeting their requirement to be formally mentored through their Provisional status. Future research could consider the applicability of the mentoring circle model across a wider graduate population to support innovative practice.

Private practice dietetics: A scoping review of the literature

AIM

Private practice is one of the most rapidly growing, but under-researched employment sectors for graduate dietitians in Australia, limiting evidence-based workforce development. This scoping review examines existing international literature to gain an understanding of the current private practice workforce size, distribution, demography and workforce development considerations, including competencies, supply and demand, remuneration and professional development activities.

METHODS

The databases MEDLINE, EMBASE, CINAHL, EMCARE, PsycInfo (Ovid) and grey literature were systematically searched in August 2023 using key search terms to identify studies for inclusion. Articles were included if they related to private practice dietetics and described an aspect of workforce. Original research, government and organisational reports, statements of practice and websites providing governmental or organisational statistics were included. A directed content analysis and qualitative constant comparison technique were used to deductively map intelligence sources against a workforce development framework. A gap analysis was also conducted to provide a focus for future workforce development research.

RESULTS

A total of 72 peer-reviewed and grey literature sources were included, with 65% of the studies being Australian-based publications. Private practice dietetics research interest has increased in the last decade. Despite a breadth of published sources, this review found little published data on workforce size, distribution, demography, supply, demand, continued professional development and remuneration, indicating a significant gap in the evidence base. Existing literature focuses on workforce challenges and barriers, the work of private practice dietitians, with limited exploration of competency requirements for graduate private practitioners.

CONCLUSIONS

The literature on the private practice dietetics workforce is lacking worldwide, which constrains evidenced-based workforce development initiatives. Workforce development research across all workforce aspects is warranted to address current evidence gaps.

An investigation of employer perceptions of Irish nutrition graduate competencies

BACKGROUND

Undergraduate nutrition programmes prepare students and graduates for a wide range of employment opportunities. However, little is known about how employers perceive current nutrition education practices in Ireland and how well graduates are prepared for the realities of today's workforce. The present study aimed to explore employers' perspectives of nutrition placement students and graduates' competencies for the workforce.

METHODS

Interviews were conducted with 12 nutrition employers across Ireland and the UK who currently or have recently employed Irish nutrition graduates or supervised placement students. Interviews were transcribed verbatim and thematically analysed.

RESULTS

Three themes were identified including: "adapting to modern workforce needs", "professional competency expectations" and "valuing competency-based educational and professional systems". Employers reported an overall positive experience with Irish nutrition placement students and graduates. They are perceived as adaptable, willing to learn and professional. Many felt nutrition students and graduates had received quality education with knowledge, skills and attitudes meeting expectations of nutrition education being provided but felt that students and graduates often lacked confidence in their abilities. Employers remarked that graduates who had undergone placements were better prepared for the professional work environment. However, gaps were identified because employers felt nutrition curricula lack training on business skills and digital competencies.

CONCLUSIONS

Employers had a positive experience with Irish nutrition graduates and students and felt they were competent for the workforce. Addressing the gaps identified by employers to adapt curricula to modern workforce needs would further enhance graduate employability.

Are recent health, welfare and care graduates part of a rural and remote workforce solution? Evidence from Tasmania, Australia

BACKGROUND

Strong growth in graduate supply from health, welfare and care courses across Australia may bode well for easing rural workforce shortages. However, little is known about the employment opportunities available for recent graduates in non-metropolitan areas. This study aimed to quantify and describe advertised job vacancies for health, welfare and care professions in Tasmania, a largely rural and geographically isolated island state of Australia. Further, it aimed to examine those job vacancies specifying that recent graduates were suitable to apply.

METHODS

Job advertisements for health, welfare and care professionals were collected weekly throughout 2018 from six online job vacancy websites. Data were extracted on 25 variables pertaining to type of profession, number of positions, location, and graduate suitability. Location of positions were recoded into a Modified Monash Model (MM) category, the Australian geographic standard used to classify rurality. Positions advertised in MM2 areas were considered regional and MM3-7 areas rural to very remote. Data were analysed using descriptive and inferential statistics.

RESULTS

Over the twelve-month period, 3967 advertisements were identified, recruiting for more than 4700 positions across 49 different health, welfare and care professions in Tasmania. Most vacancies were in the non-government sector (58.5%) and located in regional areas (71.7%) of the state. Professions most frequently advertised were registered nurse (24.4%) and welfare worker (11.4%). Eleven professions, including physiotherapist and occupational therapist, recorded a disproportionate number of advertisements relative to workforce size, suggesting discipline specific workforce shortages. Only 4.6% of collected advertisements specified that a recent graduate would be suitable to apply. Of these, most were for the non-government sector (70.1%) and located in regional areas (73.4%). The professions of physiotherapist (26.6%) and occupational therapist (11.4%) were most frequently represented in advertised graduate suitable positions.

CONCLUSIONS

Despite a range of advertised employment opportunities for health, welfare and care professionals across Tasmania, few specified vacancies as suitable for recent graduates and most were located in regional areas of the state. Health, welfare and care services in non-metropolitan locations may need to develop more employment opportunities for recent graduates and explicitly advertise these to job-seeking graduates to help grow and sustain the rural and remote health workforce into the future.

The graduate dietitian experience of employment and employability: A longitudinal qualitative research study from one Australian university

AIMS

Diet-related chronic disease contributes significantly to the global burden of disease. Dietitians are best placed to address this disease burden, yet graduate dietitians may struggle to find employment. This study aimed to explore dietetics graduates' experiences of employment and employability, up to 6-month post-degree completion.

METHODS

Secondary data analysis of in-depth qualitative interview data and longitudinal audio-diaries was undertaken. An interpretivist approach was employed whereby knowledge was viewed as subjective and multiple realities exist. A total of five entrance interviews, 31 audio-diaries and three exit interviews, from nine graduates were included in the analysis. This comprised 12 h of longitudinal audio data. Thematic analysis was undertaken using a framework analysis method.

RESULTS

Four key themes were identified: (1) The tumultuous process of applying for jobs demonstrated that graduates struggled with repeated rejections. (2) The uncertain journey to employment indicated that job-seeking was a limbo stage marked by uncertainty. (3) Feeling the pressure showed that graduates experienced pressure from multiple sources. (4) Enhancing employability explained that graduates were not prepared for available employment opportunities, but utilised resources to increase their employability.

CONCLUSION

Diverse placement experiences may better prepare graduates for available employment opportunities. To enhance employability, it may be beneficial to assist students to develop job-seeking skills, and to engage in networking and volunteering experiences during their education.

Employability and employment outcomes of nutrition science graduates: A qualitative exploration

AIMS

This study aimed to explore experiences of employability and employment for graduates of a three-year nutrition science degree.

METHODS

Qualitative narrative interviews were conducted with a maximum variation sample of 22 nutrition science graduates from one large university in Australia. All graduates (n = 126) from the initiation of the degree in 2015 to current 2021 graduates were eligible for inclusion if they had not gone on to study dietetics. The interviews elicited their stories and experiences of employability and journeys to employment post-graduation. Interviews were analysed using the framework method.

RESULTS

Analysis of the graduate interviews identified four themes: (1) from graduation to employment; (2) there are challenges to obtaining employment; (3) curriculum can enable employability; and (4) employability resources can support career prospects. In this group, the nutrition science degree on its own was not deemed sufficient to land employment in a desired nutrition-related field. The process of obtaining employment was supported by work experience, social networks, interpersonal skills, and a willingness to relocate.

CONCLUSION

Building employability skills in the curriculum through the development of professional social networks and a professional identity may be important in improving the employability of nutrition science graduates.

Development of affective learning in dietetics graduates: A qualitative longitudinal study

BACKGROUND

The development of affective learning during healthcare student education is essential for professional practice. Current studies are limited to short-term studies with medicine and nursing students. Longitudinal studies are emerging; however, the research within allied health students remains scant. The present study investigates the value of simulation-based learning activities in relation to affective learning among dietetic students.

METHODS

A double hermeneutic, interpretative phenomenological approach (IPA) approach was employed, followed by an analysis of the trajectory of participants' affective learning across three-interview time points via the application of Krathwohl's affective learning levels.

RESULTS

The simulation developed affective learning in four of the six participants, specifically in relation to their view of themselves as practitioners and their understanding of their future responsibilities to patient care. Three key themes were identified in the participants: (1) feeling of workforce readiness, (2) valuing lifelong learning and (3) attitudes towards interprofessional teamwork.

CONCLUSIONS

This IPA methodology described dietetic students' affective learning development as they transitioned to practice as graduate health professionals. Simulation-based learning is one activity that enhances students' learning in the affective domain and educators should consider its value within their programs.

Trends, challenges, opportunities, and future needs of the dietetic workforce: a systematic scoping review

CONTEXT

Issues related to nutrition and health are prominent, yet it is unclear if the dietetics workforce is being used optimally.

OBJECTIVE

Trends, challenges, opportunities, and future needs of the international dietetic workforce are investigated in this review, which was registered with Open Science Framework (10.17605/OSF.IO/DXNWE).

DATA SOURCES

Eight academic and 5 grey-literature databases and the Google search engine were searched from 2010 onward according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Of 2050 articles screened, 184 were eligible for inclusion.

DATA EXTRACTION

To chart data, a directed content analysis and a constant comparison technique were used.

DATA ANALYSIS

The following 13 themes were identified: 1) emerging or expanding areas of practice; 2) skill development; 3) economic considerations; 4) nutrition informatics; 5) diversity within the workforce; 6) specific areas of practice; 7) further education; 8) intrapersonal factors; 9) perceptions of the profession; 10) protecting the scope of practice; 11) support systems; 12) employment outcomes; and 13) registration or credentialing.

CONCLUSIONS

The dietetics profession is aware of the need to expand into diverse areas of employment. Comprehensive workforce data are necessary to facilitate workforce planning.

Rural employment: A get-go for recent nursing and allied health graduates?

OBJECTIVE

To explore the pathways recent nursing and allied health graduates have used to gain initial employment in regional and rural Tasmania.

DESIGN

A mixed-methods design comprising an online survey and semi-structured interviews.

SETTING

Tasmania, Australia.

PARTICIPANTS

Eighty-four recent nursing and allied health graduates from 18 disciplines.

MAIN OUTCOME MEASURES

Location and pathway to initial employment, job search strategies, number of job applications and length of time taken to gain employment.

RESULTS

Participants obtained their qualification from Tasmania or mainland Australia. Rural-origin graduates were more likely to work in rural locations after graduating. Graduates sought initial regional or rural employment to be close to family; to avail themselves of more job opportunities and less competition from other graduates; and for adventure. An inability to secure metropolitan jobs led others to seek opportunities in regional and rural Tasmania. Graduates that used multiple job search strategies and who were more flexible regarding location and field of initial employment experienced fewer challenges gaining employment.

CONCLUSION

For recent nursing and allied health graduates, securing initial employment can be time-consuming and labour-intensive. Being flexible, persistent and willing to adjust expectations about work location will help. Rural employment might provide the right get-go for a professional career. Understanding the pathways recent graduates have used to gain initial rural employment can help better connect graduates and prospective employers.

Exploring health care graduates' conceptualisations of preparedness for practice: A longitudinal qualitative research study

INTRODUCTION

Although preparedness for practice (P4P) has been variously described, little shared understanding exists about what P4P is across the health professions. How P4P is conceptualised matters, because this shapes how stakeholders think, talk about and act towards it. Further, multiple understandings can result in diverse expectations for graduate performance. This study therefore explores health care learners' solicited and unsolicited conceptualisations of P4P over their early graduate transition.

METHODS

We conducted longitudinal qualitative research including individual and group entrance interviews (phase 1: n = 35), longitudinal audio-diaries (phase 2: n = 30), and individual and group exit interviews (phase 3: n = 22) with learners from four disciplines (dietetics, medicine, nursing and pharmacy). We employed framework analysis to interrogate data cross-sectionally and longitudinally.

RESULTS

We found 13 conceptualisations of P4P (eg knowledge, confidence), broadly similar across the disciplines. We found some conceptualisations dominant in both solicited and unsolicited talk (eg skills), some dominant only in solicited talk (eg competence) and others dominant only in unsolicited talk (eg experience). Although most conceptualisations appeared relatively stable across time, some appeared to dominate at certain time points only (eg employability and skills in phases 1 and 2, and competence in phase 3).

DISCUSSION

This novel study extends previous uniprofessional work by illustrating a broader array of conceptualisations, differences between professions, solicited versus unsolicited talk and longitudinal cohort patterns. We encourage health care educators to discuss these different P4P understandings in graduate transition interventions. Further research is needed to explore other stakeholders' conceptualisations, and over a duration beyond the early graduate transition.

A novel blended placement model improves dietitian students' work-readiness and wellbeing and has a positive impact on rural communities: a qualitative study

BACKGROUND

Clinical placement models that require students to relocate frequently can cause stress, which may impact the student experience and development of work-readiness skills. A blended placement, where placements are undertaken concurrently at one location has potential to address these issues by providing a positive placement experience. Blended long-stay placements undertaken in rural communities increase consistent service provision and may help encourage students to work rurally, with potential to reduce workforce shortages. The aim of this study was to pilot test the feasibility of blended placement models and explore the student experience and skills development. A secondary aim was to explore a fully blended long-stay rural placement and the benefits to the rural community.

METHODS

An exploratory qualitative design was used. Focus groups were conducted with dietitian student who participated in usual placements (n = 14) or blended placements (n = 9). Individual semi-structured interviews were conducted with five student supervisors who participated in blended placements. Focus groups and interviews were recorded, transcribed verbatim and analysed together using inductive thematic analyses.

RESULTS

The overarching theme across all blended model placements was 'enhanced work-readiness', including increased flexibility, organisational skills and better preparedness for mixed roles. Enhanced work-readiness was influenced by three themes: stress and wellbeing impacts learning, working in two areas of practice concurrently allows for deeper learning, and blended placements meet supervisor needs. Fully blended long-stay rural placements revealed additional benefits. Firstly, in relation to the overarching theme 'enhanced work-readiness': students on these placements also developed extra skills in innovation, social accountability, interprofessional collaboration, conflict resolution and teamwork. Secondly, a new overarching theme emerged for fully blended long-stay rural placements: 'increased community connections' which included additional health services delivery, deeper personal experience and more rewarding student-supervisor relationships. Thirdly, two extra themes emerged that influenced work-readiness and community impact: 'local organisational support and resources' and 'enhanced innovative and interprofessional learning opportunities'.

CONCLUSIONS

Blended placements enhance work-readiness skills by providing an alternative model to that commonly applied, and providing flexibility in education programs. Additionally, fully blended long-stay rural placements positively influence the local community through impacting the student experience as well as providing more dietetics services and may therefore assist in reducing dietetics workforce shortages and health inequity.

Studying the transition from graduate to health practitioner: The Griffith Dietetics Graduate Outcomes Survey

Understanding health workforce profiles is important for planning. This study aimed to explore the experiences and influences on graduate dietitians transitioning to employment. A mixed-methods case-study design was used. Graduates of Griffith University Bachelor of Nutrition and Dietetics 2017-2019 cohorts (n = 150) were invited to participate. Purpose-developed surveys were administered prior to graduation and six-months later to examine employment outcomes. Telephone interviews were conducted with participants in the 2017 cohort using a semi-structured protocol and thematically analyzed to further explore key issues arising from the survey results. Qualitative data were synthesized using triangulation of open survey items and interview responses. Baseline data were provided by 137 graduates (91%), with 110 (80%) completing the six-month survey. At six-months, 84 of the 98 (85%) respondents seeking employment reported being employed as a dietitian (private practice, n = 46; hospital, n = 26), 39 of whom were working full-time. Key themes included the importance of networking to gain employment, willingness to relocate to rural areas, the need to persevere, and the need for supported career development. These findings can be used to inform dietetic education and workforce preparation.