Communication Skills: A Scoping Review of Experiences, Perceptions, and Use in Dietetics Practice

Advice over empathy: a national cross-sectional examination of communication in united states dietetic education

BACKGROUND

Empathy is an important element of patient communication and is well operationalized in established approaches to one-on-one communication, such as motivational interviewing (MI). The accurate demonstration of empathy is especially important when seeking to facilitate a change in behavior, such as in lifestyle or diet, given these issues often involve psychological barriers versus knowledge deficits. Registered dietitians are a key licensed healthcare provider tasked with facilitating changes in diet, but the extent to which current educational standards in the United States (US) contribute to cultivation of empathy as a professional skill has not been systematically evaluated. The objective of this study was to characterize therapeutic empathy and communication among US dietetics students.

METHODS

A cross-sectional survey-based study was conducted among US-based dietetics students, recruited via forwarded e-mail messages from directors of accredited programs. Personal characteristics and responses to the Helpful Responses Questionnaire (HRQ)- a validated measure of therapeutic empathy- were collected. All HRQ responses (6/participant) were reviewed and scored from 1 to 5 based on the use of reflections and communication roadblocks (1 = least empathetic, 5 = most empathetic) per established methods. One mean total HRQ score was computed per participant and precise roadblocks used were tabulated. Given the distribution of the final data set, a binary variable was created to capture whether participants had a total HRQ score of 1 or > 1. Logistic regression and chi-square tests were used to identify participant attributes associated with achieving scores > 1.

RESULTS

Participants (n = 506) were mostly white females (95.06% female, 79.05% white). The mean total HRQ score was 1.21 (SD: 0.47), with n = 175 participants (34.6%) achieving a mean total HRQ score > 1. Age, being married, having a previous non-nutrition-related career, or enrollment in a standalone internship were associated with HRQ score > 1 (P ≤ 0.001). The most common roadblock used was advising followed by using logic.

CONCLUSION

US-based dietetics students may not be consistently using empathetic communication, instead prioritizing problem-solving-oriented strategies (e.g., giving advice). Exploring optimal strategies to training that facilitate improved empathy, and the relative importance of empathy versus problem-solving strategies in facilitating behavior change, are important next steps. Further, the HRQ was successfully implemented, and its use should be replicated in other regions and populations.

Exploring behaviour change skill development during final placements: Practice educator and student perspectives

AIMS

The integration of behaviour change science into dietetics education is crucial for developing competent health practitioners. However, the ability of final placements to provide student dietitians with the opportunity to practice skills for supporting dietary behaviour change is not yet understood. This study aims to explore how placements shape the development of dietetics students' knowledge and skills in behaviour change through the novel approach of drawing on practice educator and student perspectives.

METHODS

Using a constructivist approach, qualitative data were collected through semi-structured interviews with practice educators and focus groups with graduating dietitians. Questions aimed to explore the practice educator role in developing student behaviour change skills and aspects of hospital placement that improved student confidence. Data were transcribed verbatim and analysed using inductive thematic analysis to identify key themes and sub-themes.

RESULTS

Eleven hospital-based practice educators and eight dietetics graduands participated. Three key themes were identified: (1) limited modelling of behaviour change within a hospital placement; (2) experiential learning needed to consolidate behaviour change skill development; and (3) the need to strengthen behaviour change science in dietetics. Throughout each theme, educators and students described challenges to skill development on placement, such as limited opportunities to practise behaviour change interventions, insufficient attention to behaviour change in feedback and assessment, and differing educator confidence in teaching these skills.

CONCLUSIONS

This study suggests a need to strengthen opportunities for students to link theoretical and practical learning of behaviour change skills to work toward producing a workforce of confident behaviour change agents.

How to educate patients and caregivers on end-of-life nutrition care and support

BACKGROUND

There are numerous articles, book chapters, and published guidelines on the topic of clinical ethics in the use of artificially administered nutrition and hydration, which often incorporates end-of-life (EOL) nutrition care and support. Components of clinical ethics involve the importance of ethical principles, patient-centered care, and shared decision-making. However, there is sparse information on how to educate patients and caregivers on this subject.

METHODS

Initially, PubMed and the Cochrane Library were used to find articles on the subject. Articles were reviewed and new concepts were identified to include.

RESULTS

There is a practice gap with not applying clinical ethics in practice. The application of clinical ethics, which includes the teach-back method of education, soft skills and behavioral skills training, and potential sacred moments, is not well addressed in the literature. Demonstration of the process of incorporating clinical ethics into practice is beneficial in helping educate clinicians so they can then effectively educate the patient and caregiver on EOL nutrition care and support. Reasons for not applying clinical ethics in actual clinical practice may be because of clinicians not receiving training, the lack of opportunity to observe the technique applied in actual clinical practice, or possibly concern for the presumed additional time required in clinical practice to apply clinical ethics.

CONCLUSION

Educating patients and caregivers on EOL nutrition care and support presupposes engaging, educating, and empowering clinicians about clinical ethics by demonstrating the process and encouraging educators to incorporate the information in an interdisciplinary/interprofessional curriculum.

Generative Artificial Intelligence as a Tool for Teaching Communication in Nutrition and Dietetics Education-A Novel Education Innovation

Although effective communication is fundamental to nutrition and dietetics practice, providing novice practitioners with efficacious training remains a challenge. Traditionally, human simulated patients have been utilised in health professions training, however their use and development can be cost and time prohibitive. Presented here is a platform the authors have created that allows students to interact with virtual simulated patients to practise and develop their communication skills. Leveraging the structured incorporation of large language models, it is designed by pedagogical content experts and comprises individual cases based on curricula and student needs. It is targeted towards the practice of rapport building, asking of difficult questions, paraphrasing and mistake making, all of which are essential to learning. Students appreciate the individualised and immediate feedback based on validated communication tools that encourage self-reflection and improvement. Early trials have shown students are enthusiastic about this platform, however further investigations are required to determine its impact as an experiential communication skills tool. This platform harnesses the power of artificial intelligence to bridge the gap between theory and practice in communication skills training, requiring significantly reduced costs and resources than traditional simulated patient encounters.