Achieving excellence in dietetics practice: certification of specialists and advanced-level practitioners

A look at the educational preparation of the health-diagnosing and treating professions: Do dietitians measure up?

Basic educational requirements for dietitians were developed almost 80 years ago and remain largely unchanged. In the interim, other health professions have increased their academic standards. A review of the educational preparation of 16 health-diagnosing and treating professions was undertaken to better understand the standards for dietetics education within a larger context. Educational standards for each profession were obtained and reviewed for types of degrees; duration of post-secondary, college-level education; division of didactic and clinical education; and presence of accredited post-professional education. Findings reveal that at least 11 of the professions studied offer first professional degrees. Differences were noted in duration and sequencing of undergraduate education, didactic or classroom education, and especially supervised practice. Models to facilitate comparison between educational standards were developed. The current educational model in dietetics is designed to prepare entry-level practitioners and academics who comprise less than 20% of the profession. This review supports the need to investigate educational opportunities for beyond-entry-level dietitians, and to develop educational programs that amplify the existing models for educating dietitians.

Nephrologists' and internal medicine physicians' expectations of renal dietitians and general clinical dietitians

OBJECTIVE

To document and compare nephrologists' and internal medicine physicians' expectations of renal dietitians and general clinical dietitians.

DESIGN

Subjects completed a mailed survey. Respondents provided demographic information and used a 5-point Likert scale to note whether each of 14 job functions was appropriate for general clinical dietitians, renal dietitians, or both.

SUBJECTS

Five hundred forty-one physicians registered with the Ohio State Medical Board (OSMB) were surveyed. Within this group were 283 nephrologists (the population of nephrologists registered with the OSMB) and 258 internal medicine physicians (selected randomly by the OSMB). A total of 133 physicians (25%) returned the survey; 119 surveys were usable: 70 from nephrologists and 49 from internists.

STATISTICAL ANALYSES PERFORMED

A composite variable was created by coding and summing physicians' responses regarding dietitian job functions. This variable was averaged for both physician categories. A t test was conducted to compare composite variable results between the two physician groups.

RESULTS

At least 50% of nephrologists and internists agreed that both types of dietitians should conduct nutrition assessments, determine patients' energy needs, evaluate medication-nutrient interactions, recommend diet and tube-feeding orders, instruct patients about physician-ordered diets, and teach nutrition concepts to hospital interns. Few physicians agreed that either type of dietitian should order diets, tube feedings, or diet instructions.

APPLICATIONS/CONCLUSIONS

Clinical dietitians can educate physicians about dietitians roles informally in their institutions and formally by supporting programs like The American Dietetic Association Physician Nutrition Education Program. In addition, dietetics educators can hone their students' communication and problem-solving skills to promote positive physician-dietitian interaction.

Interdisciplinary perceptions of the dietitian's legal responsibility for lethal dietary prescription errors for patients with end-stage renal disease

OBJECTIVE

To determine intergroup and intragroup consensus for interdisciplinary perceptions of dietitians' legal responsibility for lethal dietary prescription errors.

DESIGN

Survey research was conducted by a mail questionnaire containing four hypothetical cases in which the dietitian provides a lethal amount of dietary potassium for an anephric patient.

SETTING

Of the 90 New York State end-stage renal disease facilities contacted, 64 returned one or more questionnaires.

SUBJECTS/SAMPLES

Usable questionnaires were tabulated from 51 registered dietitians, 39 registered head nurses, and 43 physician-medical directors.

MEASURES

Consensus was recognized when 60% or more of the responses occurred in one extreme collapsed and dichotomized category of "yes" or "no" regarding the dietitian's legal responsibility.

STATISTICAL ANALYSES PERFORMED

Intergroup and intragroup consensus levels were compared by frequency, mean, standard deviation, and Scheffe test of differences.

RESULTS

The triad groups met varying levels of consensus on all four scenarios, with dissenting opinions by nurses on two scenarios. The dietitians and the physician-medical directors had mirror-image perceptions that the dietitian was not legally accountable for two cases of following foreseeably lethal dietary prescriptions "as written." Eight dietitians viewed the dietitian as legally nonculpable for causing a patient's death because of the dietitian's sole incompetence or carelessness in making a serious calculation error. Nurses met the highest levels of agreement and perceived the dietitian to be legally accountable for all four cases. The nurses, in contrast to the dietitians and physician-medical directors, held opinions of dietitian legal responsibility as consistent with the standard of care expectations of prudent health care professionals defined by professional malpractice jurisprudence.

APPLICATIONS/CONCLUSIONS

The data indicate that to protect both the patient and the professional, there is a notable need for greater understanding dietetics jurisprudence.