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UBC Dietetics Program FEED Preceptor Teleconference November 30, 2017

Nutrition Care Preceptors: A session just for you!. UBC Dietetics Program FEED Preceptor Teleconference November 30, 2017. To join the teleconference:

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UBC Dietetics Program FEED Preceptor Teleconference November 30, 2017

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  1. Nutrition Care Preceptors: A session just for you! UBC Dietetics ProgramFEED Preceptor Teleconference November 30, 2017 To join the teleconference: From the Vancouver area, call 604-899-2339From outside Vancouver, call toll-free 1-877-385-4099After calling the number, enter the password, 8774290#

  2. Today’s plan • Nutrition Care Modules: Purpose and Structure • Teaching and Learning Resources • Discussion • Mini-workshop • Approaches to common challenges • Wrap-up

  3. NC Modules: Purpose & Structure Changes made to the program in 2013 to address Integrated Competencies for Dietetic Education and Practice (ICDEP): • Terminology changes (clinical vs nutrition care) • New competency and performance indicator language • 22 week experience, split into NC I, II and III modules • Decreased focus on exposure to all areas of practice; emphasis on broad skill development

  4. NC Modules: Purpose & Structure NC domain competencies: • Assess nutrition-related risks and needs (14 indicators) • Develop nutrition care plans (10 indicators) • Manage implementation of nutrition care plans (4 indicators) • Evaluate and modify nutrition care plans (4 indicators)

  5. NC Modules: Purpose & Structure Additional NC competencies: NC I, II and III: • Progress towards managing a small patient caseload NC II only: • Design enteral feeding (8 indicators) • Design parenteral feeding (5 indicators) • Deliver group education sessions (comm. & collaboration) • Develop learning resources (comm. & collaboration) • Develop effective patient/client counseling approaches (comm. & collaboration)

  6. NC Modules: Expectations Key expectations • Interns manage the module forms • Module requirements section (page 2) - an intern responsibility • Intern to identify learning goals and draw preceptor attention to module activities and timelines • Preceptors provide support and guidance • Teach intern practical skills & applications of knowledge • Provide ongoing feedback to support development • Verify competence through evaluation

  7. What do students learn prior to internship? • Foundational knowledge is guided by ICDEP • ICDEP Foundational Knowledge mapping project: • All ICDEP knowledge is covered in dietetics coursework • Varied complexity: broad knowledge to comprehension to application

  8. What interns should know on day 1 of internship ICDEP knowledge areas related to NC: • Anatomy & Physiology • Biochemistry • Food • Health System in Canada • Human Nutrition Across the Lifespan • Microbiology • Nutrition Assessment • Nutrition Care Process & Medical Nutrition Therapy • Pharmacology • Population Food Systems and Food Security • Communication • Teaching & Learning

  9. What interns should know on day 1 of internship Nutrition Care Process & Medical Nutrition Therapy • Etiology and pathophysiology of nutrition-related diseases • Nutrition-related disease management strategies • Use of assessment, diagnosis, intervention, monitoring, evaluation (ADIME) in medical nutrition therapy • Calculation of energy and nutrient requirements for conditions/diseases • Goal setting and outcome measurement in nutrition therapy • Oral, enteral, and parenteral nutrition support • Feeding assessment, including identification of chewing, swallowing and feeding problems • Complementary and alternative nutrition therapies

  10. What interns should know on day 1 of internship Human Nutrition Across the Lifespan • Ingestion, digestion, absorption, metabolism and excretion of nutrients • Biochemical utilization of nutrients and energy • Nutrient and energy requirements • Physical activity and energy balance • Nutrition recommendations and guidelines • Effect of deficiencies and toxicities of nutrients • Food sources of nutrients and dietary supplements • Role of nutrients and other food components in health • Dietary practices

  11. What interns should know on day 1 of internship Food • Physical properties and chemical composition of food • Food preservation, storage and packaging • Role of ingredients and their interaction in food preparation • Household food preparation • Application of dietary requirements, guidelines, guidance tools to food planning • Food modification to address therapeutic, textural or other needs • Sensory evaluation of food • Religious and cultural food practices • Food labeling • Food-borne illness

  12. What interns should know on day 1 of internship Population Food Systems and Food Security • Food production, preparation, processing, distribution and waste management • Global and local food systems and factors affecting the supply of food • Sustainable food practices • Food markets and marketing of food • Factors affecting access to food • Disaster planning • Food consumption patterns and trends

  13. Teaching & Learning Resources • NC module forms • Each form has a checklist section to assist preceptor and intern to plan activities to meet competencies • Teaching skills handouts: http://dietetics.landfood.ubc.ca/preceptors/preceptor-resources/handouts/ Topics developed based on preceptor feedback: • Giving Effective Feedback • Setting the Stage for Success • Promoting Critical Thinking

  14. Teaching & Learning Resources Learning Resources for Interns: • Nutrition Tracking Form • Tube feeding modules & simulations (NC II only)

  15. Mini-workshop Promoting Critical Thinking Image source: http://admin.myrepublica.com/opinion/story/31201/covering-the-fields.html

  16. Mini-workshop 1 minute activity With a partner or on your own: What questions do you ask interns when you are working with them in a placement?

  17. Mini-workshop Critical thinking is: • “Thinking about your thinking” • Often used interchangeably with clinical reasoning Characteristics of a critical thinker: • Asks insightful and thoughtful questions • Gathers & assesses relevant information before reaching a conclusion • Thinks open-mindedly • Recognizes and challenges assumptions (own and of others) • Can communicate his/her thought process to others

  18. Examples of questions you can use to promote critical thinking: In NC I • What is happening with this patient? • What information do you have about the patient/client/resident that is relevant to our role as dietitians? • How did you come to that conclusion? (e.g. about a nutrition diagnosis, intervention, a patient’s needs or desires etc.) In NC II • How is this situation similar to ones you’ve seen before? And different? • What assumptions might influence your decisions with this patient/client? • How did you integrate the information you have to make this decision? (e.g. nutrition evidence, unique patient/family situation, ethics, organizational policy/practice etc.) In NC III • What options do we have for this patient’s/client’s nutrition care? • Are there pros and cons to consider for each option? • How is your past experience influencing your decision-making?

  19. Mini-workshop - circling back

  20. Discussion Your thoughts, questions, ideas on: • Techniques to assess intern competency • Juggling responsibilities of your job with hosting interns

  21. Wrap-up A few final considerations for working with interns: • Philosophy of intern self-directed learning • Interns are responsible for owning their learning and ensuring they are on track to meet competencies • Concerns with intern performance? • We’re here to help!

  22. FEEDBACK from interns/preceptors • Feedback collected regularly: • Modules and forms: annually (preceptors, interns, coordinators) • Intern satisfaction survey: annually • Preceptor satisfaction survey: every 2 years • Intern and preceptor surveys: • Satisfaction measured with 5-point Likert scales • Open-ended questions - things that work well, opportunities for improvement

  23. FEEDBACK from interns/preceptors Preceptor survey 2017 • Respondents (n=100): NC I - 22, NC II - 56, NC III - 22 • Respondents mostly satisfied with NC modules • Mean scores of 3.79 to 4.36 out of 5 • Majority of means over 4 • Lowest scores related to: intern academic preparedness (mostly in NC I & II) • Anticipate low scores to improve next year with implementation of revised nutrition care courses - FNH 470 & FNH 475

  24. FEEDBACK from interns/preceptors Preceptor survey 2017 Things that worked well: • Module forms are an improvement from past years – e.g. placement planning checklist, performance guide; less time consuming to complete • Having a plan for readings, questions etc. for intern to complete before/during placement • 3-week placement length is an improvement • Interns who are well-prepared, motivated and self-directed with their learning do well • Active participation in NC I sets them up well for NC II (rather than primarily observing)

  25. FEEDBACK from interns/preceptors Preceptor survey 2017 Improvement Opportunities: • Clearly communicate expectations that interns need to do self-directed work on their own time to support learning • Difficult to manage time and workload while supporting an intern • Clarify expectations re caseload (particularly for NC III) • More independence earlier in NC modules to better prepare interns for NC II & III, particularly ensuring hands-on practice in NC I

  26. FEEDBACK from interns/preceptors Intern survey 2017 • All interns respond to survey (n=34), requirement of internship • Generally high satisfaction with NC (means above 4) • Long standing low satisfaction with academic preparedness (2017 mean = 2.79) • Anticipate low scores to improve next year with implementation of revised nutrition care courses - FNH 470 & FNH 475

  27. FEEDBACK from interns/preceptors Intern survey 2017 Things that worked well: • Progressive NC module structure is helpful (NC I, II, III), particularly progressive independence • 3 week placement length helps to build confidence • Open communication/feedback with preceptors • Mix of inpatient and outpatient experiences

  28. FEEDBACK from interns/preceptors Intern survey 2017 Improvement Opportunities: • Ensure expectations are consistent between placements (especially within the same NC module) • Clarify caseload management expectations (particularly in NC II and NC III) • All placements at least 3-weeks long • Learning curve in NC I is steep, better preparation for this prior to internship

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