Download Rationale for Future Education Preparation of Nutrition and Dietetics

Rationale for Future Education Preparation
of Nutrition and Dietetics Practitioners
February, 2015
Updated: July, 2015
Updated: August, 2015
Updated: January, 2017
Updated: March, 2017
Copyright ©2015 Accreditation Council for Education in Nutrition and Dietetics
Table of Contents
EXECUTIVE SUMMARY .................................................................................................................................... 3
BACKGROUND ON ACEND® ............................................................................................................................. 6
PROPOSED MODEL FOR EDUCATION IN NUTRITION AND DIETETICS ........................................................... 10
ENVIRONMENTAL SCAN ................................................................................................................................ 13
STAKEHOLDER INPUT .................................................................................................................................... 40
STAKEHOLDER INTERVIEWS AND ANALYSIS .............................................................................................. 41
STAKEHOLDER SURVEY DATA COLLECTION AND ANALYSIS ...................................................................... 42
EMPLOYER DATA COLLECTION AND ANALYSIS.......................................................................................... 56
COMPETENCY GAP ANALYSIS .................................................................................................................... 67
STAKEHOLDER INPUT ON FUTURE MODEL RECOMMENDATIONS ............................................................ 69
ADDITIONAL INFORMATION GATHERED IN THE DEVELOPMENT OF THE FUTURE EDUCATION MODEL
STANDARDS AND COMPETENCIES ................................................................................................................ 78
ASSOCIATE DEGREE NUTRITION HEALTH WORKER .................................................................................. 79
ASSESSMENT OF THE 2012 ACEND® ACCREDITATION STANDARDS ......................................................... 84
DEVELOPMENT OF THE FUTURE EDUCATION MODEL COMPETENCIES & PERFORMANCE INDICATORS .... 89
PUBLIC COMMENTS ON THE FIRST DRAFT OF THE FUTURE EDUCTION MODEL ACCREDITATION
STANDARDS FOR ASSOCIATE, BACHELOR AND MASTER DEGREE PROGRAMS .......................................... 146
REFERENCES
APPENDIXES (Separate File)
Appendix A Background Report
Appendix B State Scope of Practice
Appendix C Stakeholder Questionnaire
Appendix D Employer Questionnaire
Appendix E Frequently Asked Questions
Appendix F Stakeholder Input on Future Model Questionnaire
Appendix G 2012 Standards Survey
Appendix H Associate Degree Competency Questionnaire
Appendix I Bachelor Degree Competency Questionnaire
Appendix J Master Degree Competency Questionnaire
Appendix K Public Comment Questionnaire Fall 2016
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EXECUTIVE SUMMARY
INTRODUCTION AND PURPOSE OF REPORT
The Accreditation Council for Education in Nutrition and Dietetics (ACEND®) serves the public by
establishing and enforcing standards for the educational preparation of nutrition and dietetics practitioners
and by recognizing nutrition and dietetics education programs that meet these standards. The educational
preparation of dietitian nutritionists and nutrition and dietetics technicians includes didactic and supervised
practice components completed through ACEND-accredited programs. The educational preparation of
nutrition and dietetics technicians is at the associate degree level and the preparation of dietitian
nutritionists is typically at the bachelor degree level, combined with or followed by a supervised practice
experience. Some master and doctoral level programs also exist.
In 2012, ACEND began discussions on future education needs and the potential of developing degree based
standards. Also in 2012, the Academy of Nutrition and Dietetics’ Council on Future Practice released a
visioning document recommending that the level of educational preparation for dietitians be elevated to a
graduate level to provide a greater depth of knowledge and skills needed for future practice in the
profession. In 2013, ACEND began work with a visioning group to explore future practice and the
education required to prepare students for this practice. ACEND collected data from key stakeholders and
conducted a thorough environmental scan to inform its review of the current standards for nutrition and
dietetics education and is recommending a new model of education that includes moving the educational
preparation of entry level generalist dietitian nutritionists to the master degree level, moving the
educational preparation of entry level nutrition and dietetics technicians to the bachelor degree level and
creating a new program preparing nutrition health associates at the associate degree level.
The purpose of this report is to summarize data collected in multiple projects conducted with
stakeholders, share information collected and recommend a model for future education of nutrition and
dietetics practitioners.
UPDATES TO RATIONALE DOCUMENT
ACEND updates this Rationale Document as new information becomes available and new decisions are
made about the recommended future education model in nutrition and dietetics. Updates that have been
added to the document include:

February, 2015
Release of the original Rationale Document

July, 2015
Summary of stakeholder comments on the recommended model section added
Title of associate’s degree practitioner changed to Nutrition Health Worker

August, 2015
Additional data collection about Nutrition Health Associate section added

January 2017
Evaluation of the 2012 Accreditation Standards
Development of competencies and performance indicators

March 2017
Summary of public comments on the draft Future Education Model
Accreditation Standards for Associate, Bachelor and Master Degree Programs in
Nutrition and Dietetics
1
ENVIRONMENTAL SCAN
The environmental scan included review of more than 100 relevant articles detailing research data,
industry trends and the changing health care and business environments. Data collected revealed
an emergence of many non-traditional practice settings for the field of nutrition and dietetics and
an expanding scope of practice for those working in the profession. There is an increased focus on
disease prevention and integrative healthcare and the need for more knowledge in emerging areas
such as nutritional genomics, telehealth, nutritional pharmacology, case management, behavioral
counseling, prescriptive authority, coding and reimbursement, evidence-based practice and
informatics. There is a growing importance for health care professionals to be educated to work
more interprofessionally. A graduate degree represents the entry level professional practice
degree for most of the health professions and all of the health professions require supervised
practice (or its equivalent) as part of their overall training and education.
STAKEHOLDER INPUT ON FUTURE PRACTICE IN NUTRITION AND DIETETICS
Four different data collection projects were completed to gather information from stakeholder
groups (employers, practitioners, educators, administrators, professionals working with nutrition
and dietetics practitioners and students) about future practice in nutrition and dietetics.
A total of 10 structured interviews were held with representative stakeholders to elicit their views
for future practice. Stakeholders interviewed indicated that communication skills, the ability to
understand and work with patients in their cultural ecosystem and patient assessment skills are
under developed or lacking in current graduates. They stated that graduates of the future will
need to be able to effectively work in interprofessional and interdisciplinary teams, interpret and
apply scientific knowledge and have strong organizational leadership and project management
skills. Stakeholders voiced that bachelor degree graduates are needed in positions of health and
wellness, management and marketing. They viewed the master’s degree as the ideal minimum for
dietitian nutritionists.
Two questionnaires were developed to collect data on skills in six skill set categories: professional
research and practice skills; teamwork and communication skills; clinical client care skills;
community and population health skills; leadership, management and organization skills; and food
and foodservice systems. These categories were developed based on input collected in the
stakeholder interviews and skills were identified within each category. One questionnaire was
designed to collect data from a broad base of stakeholders (practitioners, employers, educators,
administrators, students and professionals working with RDNs and NDTRs) that requested
respondent opinions on the importance of 79 skills for future practice in nutrition and dietetics on
a four-point importance scale; 9,477 stakeholders responded. Results indicated most (89%) of the
79 individual skills were important (i.e. mean score > 3 on a four-point scale) for future practice in
nutrition and dietetics; 40% of the skills were rated greater than 3.5 suggesting they were very
important. All six skill set categories were scored as important for future practice with teamwork
and communication skills receiving the highest mean score (M=3.64) and leadership, management
and organizational skills the lowest mean score (M=3.15). Differences in means scores were found
based on respondent’s work setting, education level and years of work experience.
The second questionnaire was designed specifically to collect additional information from
employers on how essential 69 different skills were for employability in nutrition and dietetics
practice in the future on a four-point essential scale; 300 employers provided their perceptions.
Results indicated most (86%) of the individual skills were essential (i.e. mean score >3 on a fourpoint scale) for employability in future nutrition and dietetics practice. All six skill category sets
were scored essential for future employability in nutrition and dietetics practice with teamwork
and communication skills receiving the highest mean score (M=3.52) and community and
population health skills the lowest mean score (M=3.03). Few differences were found in mean
scores based on respondent’s demographic information.
Focus groups were held with four groups of educators, practitioners, preceptors and employers (27
total participants) to explore gaps in the current competencies in the ACEND 2012 Accreditation
Standards. Several themes emerged from the focus group discussions: Master degree education
for RDNs was well supported; more time was needed for application of knowledge and
demonstration of skills (practical experience) in the programs; inconsistency existed in the program
and internship expectations; undergraduate programs must include transferable skills for other
professional direction (e.g. leadership, business, management); graduate level could offer
specialization; and need for an increase number of RDNs teaching the programs. Gaps were
identified in the current competencies in areas of research, communication,
leadership/management skills, cultural care, interprofessional work, basic food and culinary
preparation and sustainability.
RECOMMENDATIONS FOR FUTURE EDUCATION
The environmental scan, stakeholder and employer interviews, focus groups, and survey data
documented the need for increased knowledge, more complex decision making, and a broader
array of skills for future practice in nutrition and dietetics. As a result, ACEND is recommending:

Master’s degree preparation for entry level, generalist, registered dietitian nutritionists.

Bachelor’s degree preparation for entry level food and nutrition practitioners eligible to
take the registration examination to become nutrition and dietetics technicians, registered.

Associate’s degree preparation for nutrition health associates.

Each degree level has competencies identified.

Experiential learning integrated into each degree program.

Each degree level prepares graduates for employment.

Completing one part of the educational model would not be a requirement to enter a
program at a higher degree level in the model, but each degree level would build on the
preceding degree level knowledge and competence.
Future exploration of high school and doctoral level programs.

ACEND plans to develop new standards for the associate, bachelor and master’s degree level
programs and release them for multiple rounds of public comment in 2016. Once revisions are
made and the new standards and competencies are finalized, ACEND plans to release them in 2017
for voluntary adoption by demonstration programs. Outcomes data on graduates of these
demonstration programs will be collected and analyzed before ACEND makes a decision about
implementation of the recommended future model for all programs. ACEND will work with the
Commission on Dietetic Registration to define credentialing options for those completing these
new degree programs. Additional information is available at www.eatrightpro.org/acend.
These recommendations will not change the current ACEND accreditation standards. Currently
accredited programs will continue to be accredited under the 2017 Accreditation Standards.
Programs will be given the opportunity to choose whether to voluntarily adopt the new Future
Education Model Standards when these standards are released in the future.
STAKEHOLDER INPUT ON RECOMMENDATIONS
ACEND collected opinions from stakeholders about the recommended future model for education
through an online survey, reviewed survey results collected by other educators, and attended
area meetings of the Nutrition and Dietetics Educators and Preceptors. Themes of benefits and
concerns were identified through qualitative analysis of responses. Informational materials and
webinars were developed to help address questions and concerns raised about the recommended
future education model.
ADDITIONAL INFORMATION ON NUTRITION HEALTH ASSOCIATE
After the release of the Rationale Document, many questions were raised about the role of the
associate’s degree prepared practitioner in the community setting. To better understand this
potential future role, ACEND hired a consultant to conduct focus groups with RDNs who work in
community and public health practice and in depth interviews with leaders in community support
worker programs. Results of the data collection confirmed the role for a community worker who
could provide support for compliance, acceptance and management of nutritional, physical and
mental health concerns in community settings. The role and the training for this practitioner
currently is not standardized and can range from a high school diploma (for the most part) to a
certificate or AA in a health related field.
ASSESSMENT OF THE 2012 ACEND® ACCREDITATION STANDARDS
ACEND worked with a consultant to gather information from various stakeholders to determine
potential changes that might be made to improve on the 2012 ACEND Accreditation Standards for
Programs in Nutrition and Dietetics. A total of 407 individuals responded to the survey about the
2012 Standards; most were nutrition and dietetics program directors (53%) or educators (22%).
Based on a review of the quantitative and qualitative comments, several changes were
recommended including: publish the standards alone in one document; publish a separate
document for the guidance material; differentiate what is the standard and what is supporting
material; use term “evaluation” for the measurement of program objectives and “assessment” for
the measurement of the attainment of student learning outcomes and combine and streamline
the standards.
DEVELOPMENT OF COMPETENCIES AND PERFORMANCE INDICATORS
ACEND contracted with a consultant to conduct a multi-round Delphi study to gather input from a
broad base of stakeholders to gain consensus on professional and clinical competencies for future
entry-level nutrition and dietetics professionals. Entry-level competencies (knowledge, skill and
judgment) needed upon graduation from an accredited nutrition and dietetics education program
for early years of practice were identified.
The first round involved a group of 15 experts termed subject matter experts (SME). The SMEs
determined a competency framework, developed a competency outline, determined desired
complexity of competency topics for each academic degree and wrote competencies and
performance indicators for future practitioners prepared at the associate, bachelor and master
degree levels.
The second step of the Delphi process was a first line review by a group of educators and
practitioners who participated in online focus groups. A total of 98 individuals participated in one
of 10 focus group sessions to review the draft competencies and performance indicators and offer
suggested changes to content and assigned academic level.
A third step in the process involved completion of an online questionnaire. More than 1,000
nutrition and dietetics practitioners, educators, employers and professionals from outside the
field of nutrition and dietetics rated importance to future practice for the competencies and
performance indicators.
A consensus panel reviewed the Delphi study findings and reached consensus on the final
competency and performance indicator statements. Decisions were made on the wording and
inclusion of each competency and performance indicator based on the input received. As a result,
the total numbers of competencies and performance indicators included in the draft Future
Education Model Standards were 20 competencies and 121 performance indicators for the
associate degree, 38 competencies and 216 performance indicators for the bachelor degree and
41 competencies and 278 performance indicators for the master degree.
PUBLIC COMMENTS ON THE DRAFT FUTURE EDUCATION MODEL
STANDARDS
ACEND finalized the first draft Future Education Model Standards for Associate, Bachelor and
Master Degree Programs and released them for public comment. Input on the draft standards was
received from more than 1,200 individuals who provided input to an online survey, more than 200
provided input at the Educator Roundtables at FNCE and nine organizations provided written and
telephone input on behalf of their groups. Responses were received from program directors,
faculty members, preceptors, practitioners, employers, students/interns and some from outside
the profession. There were a wide array of opinions, often conflicting opinions, which were
received. ACEND made several major changes in the draft standards as a result.
BACKGROUND ON ACEND®
AND CURRENT MODEL FOR EDUCATION
OF NUTRITION AND DIETETICS PRACTITIONERS
2012 MODEL FOR EDUCATION IN NUTRITION AND DIETETICS
Accreditation Council for Education in Nutrition and Dietetics
The Accreditation Council for Education in Nutrition and Dietetics (ACEND®), the accrediting agency for
the Academy of Nutrition and Dietetics (Academy), serves the public by establishing and enforcing
standards for the educational preparation of nutrition and dietetics practitioners and by recognizing
nutrition and dietetics education programs that meet these standards. The mission of ACEND is to ensure
the quality of nutrition and dietetics education to advance the practice of the profession and its strategic
goals include: assuring the quality of dietetics education through a peer review process, effectively
communicating the accreditation process and expectations and fostering innovation in nutrition and
dietetics education.
As shown in Table 1, in 2015, there were more than 570 active US-based and international accredited
programs.
Table 1: Number of accredited dietetic programs
Total Number of Active US-Based ACEND Programs
572
US Dietetic Technician Programs
US Coordinated Programs
US Didactic Programs
US Dietetic Internships
US Programs Seeking Candidate Status
International Programs Seeking Candidate Status
International Coordinated Programs
42
55
223
252
10
1
4
Nutrition and Dietetics Education
The educational preparation of dietitian nutritionists and dietetic technicians includes didactic and
supervised practice components completed through ACEND-accredited programs. Figure 1 includes the
current model of dietetics education based on the 2012 Standards and depicts the multiple ways that
students can complete the didactic and supervised practice components for the education to become a
dietetic practitioner.
The educational preparation of dietetic technicians is at the associate’s level and the preparation of
dietitian nutritionists is typically at the bachelor’s level, combined with or followed by a supervised practice
experience. Some master’s and doctoral level programs also exist. The most common route has the
required core knowledge for practice being included in didactic programs in dietetics (DPD) and the
competencies in dietetic internships (DI) or individualized supervised practice pathways (ISPP).
Coordinated programs include both the required knowledge and competencies in one program.
Standards, which include the required core knowledge and competencies, have been developed for each
type of dietetics program. These standards can be found on the ACEND website at www.eatright.org/acend.
7
1
All programs, regardless of degree level, meet the same ACEND didactic knowledge and/or supervised practice requirements
2
Requires acceptance through application process
3
Only available to students are not matched with a dietetic internship
4
Program may or may not require completion of the graduate (master’s, doctoral) degree
Figure 1. 2012 ACEND accreditation standards model of dietetics education
8
ACEND has developed two types of standards for oversees programs: International Dietitian Education
(IDE) and Foreign Dietitian Education (FDE) programs. Students in a program accredited under IDE
standards are required to meet the same competency and supervised practice requirements as US
students, including the requirement to complete supervised practice hours in the US, its territories or
protectorates and are eligible to sit for the Commission on Dietetic Registration credentialing exam for
dietitians. Students in programs accredited under FDE standards are prepared for nutrition and dietetics
practice in their country.
ACEND also has developed Advanced Practice Residency Program Guidelines. These Guidelines provide
information for advanced practice residency programs across the spectrum of dietetics practice.
ACEND Review and Revision of Standards
ACEND is required by the United States Department of Education to review and revise if needed, its
educational standards at least once every five years. The ACEND Standards Committee is charged with
undertaking this review and recommending any needed standards revisions to the ACEND Board.
In 2006, an American Dietetic Association Education Task Force recommended a review of the educational
competencies to allow more opportunity to meet future practice needs through a graduate degree. In
2012, the Academy’s Council on Future Practice released a visioning document recommending that the
level of educational preparation for dietitians be elevated to a graduate level to provide a greater depth of
knowledge and skills needed for future practice in the profession. In response, ACEND began conducting a
thorough review of the current standards for nutrition and dietetics education. An expanded standards
workgroup was formed to develop recommendations for the ACEND board related to future education
standards. The group elicited input from a visioning group during the process.
Expanded Standards Workgroup Members
Elaine Molaison, PhD, RD, Chair
Maxine McElligott, MA, RD, LMNT, CDE, Co-chair, graduate level
Pascale Jean, MPH, RD, LD/N, Co-Chair, bachelor’s level
Sue Abbe, PhD, RN
Wanda Eastman, PhD, RD, LD Jamie Erskine, PhD, RD Amelia Larkin, MS, DTR
Joan Straumanis, PhD
Visioning Workgroup Members (Area of Representation)
Carol Turner, PhD, RD, LD (public health)
E.C. Henley, PhD, RD, LD (business and industry)
Kaylene Coffey, MAEd, RD, LD (clinical nutrition/foodservice management)
Janet Bezner, PT, PhD (physical therapy)
Joel Kopple, MD (medicine- renal research and practice)
This document offers recommendations for the future education of nutrition and dietetics practitioners
and provides rationale for those recommendations. ACEND believes the education model being
presented meets the needs of the public, protects the public, prepares competent practitioners, is based
on evidence and is feasible to implement.
9
PROPOSED MODEL FOR EDUCATION
IN NUTRITION AND DIETETICS
10
PROPOSED MODEL FOR FUTURE EDUCATION IN NUTRITION AND DIETETICS
The environmental scan and additional data collected by ACEND revealed an emergence of many
non-traditional practice settings for the field of nutrition and dietetics and an expanding scope of
practice for those working in the profession. There is an increased focus on disease prevention and
integrative healthcare and the need for more knowledge in emerging areas such as genomics,
telehealth, behavioral counseling, diet order writing and informatics. This work requires that
health care professionals work more interprofessionally. Employers indicated the need for
improved communication skills in nutrition and dietetics practitioners and an improved ability to
understand the patient’s community and cultural ecosystem. Practitioners need to be able to read
and apply scientific knowledge and interpret this knowledge for the public. Employers also
expressed a desire for stronger organizational leadership, project management, communication,
patient assessment and practice skills. Many of the stakeholders identified gaps in current
competencies in areas of research, communication, leadership/management skills, cultural care,
interprofessional work, basic food and culinary preparation and sustainability. Employers
indicated that more time might be needed in the preparation of future nutrition and dietetics
practitioners to assure application of knowledge and demonstration of skills needed for effective
practice. Stakeholders identified the importance of associate and bachelor level prepared
graduates for roles in community health, wellness and management. Employers identified the
need for preparing undergraduates with transferable skills in leadership, business and
management and expressed the need for faculty prepared at the doctoral level.
As a result, ACEND is recommending the development of new graduate level standards to prepare
generalist and specialist dietitians for these future roles. The recommended new model also
includes new associate and bachelor level standards to better prepare graduates for emerging roles
in community nutrition and health, wellness, business and industry and management.
Figure 2 depicts the recommended future model for education in nutrition and dietetics.
Education at the high school and associate’s degree levels focus on the development of skills to
work in community nutrition, health and wellness settings. The bachelor’s level preparation is
recommended to include a science base and courses core to nutrition and dietetics practice,
elevate preparation of dietetic technicians and may provide prerequisite preparation for graduate
study. Preparation for practice as a dietitian nutritionist is recommended to move to the graduate
level with generalist preparation occurring at the master’s level and specialized preparation at the
doctoral level.
Core knowledge and competencies will be identified for each degree level and experiential learning
would be integrated into each degree program. Each degree level would build on the knowledge
base of previous degrees and prepare students for employment. ACEND’s initial focus will be to
develop standards, which will include the required core knowledge and competencies, for the
associate, bachelor and master level programs. Once the new standards and competencies are
finalized, ACEND will release them for voluntary adoption by demonstration programs. Outcomes
data on graduates of these programs will be collected and analyzed before ACEND makes a decision
about implementation of the recommended future model for all programs.
11
Figure 2. Proposed model for future education in nutrition and dietetics
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ENVIRONMENTAL SCAN
ENVIRONMENTAL SCAN
By Anne M. Davis, PhD, RD and Sandra G. Affenito, PhD, RD, CD-N
In February 2014, an ACEND® appointed Expanded Standards Workgroup began exploration of degreebased standards and competencies for nutrition and dietetics practitioners. The initial work by the group
was to assess existing research and environmental scan data and collect additional stakeholder and
market-place data, if needed, to identify the roles of future practitioners, the education level required and
the needs of the marketplace. In July, 2014 a Background Report (Appendix A) was released that provided
a summarized overview of the forthcoming evidence-based Rationale Document for the future educational
requirements of bachelor’s and graduate level prepared nutrition and dietetics practitioners. Three
themes emerged from the environmental scan:
1. Continuous high-speed advancements in healthcare, technology, medicine and food systems
warrant additional information and a higher level of education may better prepare nutrition and
dietetics practitioners to meet the needs of the public.
2. There is a broadening and increased complexity in public health nutrition, food safety, disease
prevention, food production and health promotion that may impact the practice of nutrition and
dietetics.
3. Many health professions have identified differing skills levels needed by their practitioners in the
marketplace and as a result many accrediting agencies have differentiated knowledge and skill
requirements at bachelor’s and graduate levels.
These themes were explored further. Research data, industry trends and the changing health care
environment were explored and results summarized in this document.
ACADEMY OF NUTRITION AND DIETETICS DATA
Workforce Demand Study
The Dietetics Workforce Demand Study Task Force was an appointed collaboration with 14 thought leaders
by the Commission on Dietetic Registration (CDR) in 20121. The Task Force was charged to conduct an
extensive literature review, future scanning with expert opinion, public policy examination, and analysis of
numerous research surveys; and to offer viewpoints on the future of nutrition and dietetics practice from
2012 to 2022. The goal of this systematic approach was to identify and analyze change in nutrition and
dietetics practice since the last workforce study was conducted greater than 30 years earlier.
The Task Force report indicated that employers wanted to hire leaders “who can innovate, solve problems
and organize diverse individuals into results-oriented teams2.” Employers valued adaptability,
interdisciplinary perspective and leadership qualities. Demand for nutrition and dietetics services was
predicted to increase due to health care reform and the expansion of health care services to an additional 30
million people. The report suggested that approximately 75% of the demand for dietetics services would
be met by the 2020 supply of dietetics workforce which left 25% as an unmet need.
14
Credentialed dietetics practitioners’ characteristics in 2010 included an average age of 44 years, 96% were
women and about 55% worked in clinical dietetics. The net supply of CDR credentialed dietetics practitioners
was projected to grow by 1.1% annually. The report indicated that the public will have more options for
nutritional advice from the rise in homeopathy and other sources of alternative (natural) medicine.
Therefore, without an adequate supply of nutrition and dietetics professionals, the competitive space for
registered dietitian nutritionists (RDN) may be challenged.
The report identified the aging population, health care reform, increasing prevalence of certain conditions
(including obesity) and growth in the food industry as key factors affecting the demand for nutrition and
dietetics practitioners3. This excess demand will provide opportunities for non registered nutrition
practitioners (e.g., naturopathic physicians, athletic trainers, nurses and other health professionals) to
provide dietitian services. The task force study authors recommended proactive interventions that included:
increasing the supply of RDNs by increasing the number of dietetics internship positions, marketing new
employment opportunities to potential nutrition and dietetic students and creating professional growth
opportunities.
Dietetics Practice Audits
The National Commission for Certifying Agencies requires that CDR periodically conduct practice audits to
delineate performance areas and duties associated with knowledge and/or skills and examination
content/item specifications used for certification. CDR uses audit data to develop RDN and dietetic
technicians, registered (DTR) examination content. ACEND also uses audit findings to develop and revise
educational standards and competencies.
2010 Entry Level Practice Audit. CDR conducted this audit to better understand the level and frequency of
involvement and perceived risk associated with nutrition and dietetics activity statements of entry- level
(EL) RDNs and DTRs in the first 3 years of practice4. An expert panel of RDNs and DTRs, representing
multiple and diverse areas of dietetics practice, developed and categorized 166 activity statements for the
mixed mode survey instrument. A total of 2,556 surveys were sent out and a 74% response rate was
achieved. The results identified that 95% of the EL RDNs held a bachelor’s, 39% a master’s and 1% a
doctorate degree. Current positions held by the EL RDNs varied with 31% in clinical, 10% long-term care,
8% Special Supplemental Nutrition Program for Women, Infants and Children, 4% private practice and 3%
each for pediatric/neonatal, nutrition support and general outpatient positions. The survey activity
categories that were most frequently done by the EL RDNs included providing nutrition care
community/clinical general, providing nutrition care to individuals and managing food and other material
resources 4. The EL RDNs were asked to rate the most high risk activities and their categories. Several of the
high risk-rated activity statements were also core activity statements. The survey results indicated that the
majority EL RDNs performed activities related to nutrition care delivered to individuals and groups, mostly
patients (not populations), significantly more than management or research activities. Most of the EL RDNs
were employed in clinical dietetics and they did not identify core activities in research, human resource
management or other management areas.
Dissimilarly, EL DTRs performed a broader scope of food and other material resource management
activities and a smaller number of nutrition care–related activities to individuals and groups.
15
2013 DPD Practice Audit. The purpose of this audit was to delineate the practice of bachelor’s prepared EL
non-RDN practitioners5. The sample consisted of current Pathway III DTRs (Bachelor’s degree graduates and
completion of an ACEND DPD) (PIII DTR); PIII DTR eligible; and recent DPD graduates. A questionnaire was
sent to 3,789 graduates and 1,784 responded (47%). The survey instrument used was similar to the one
used in the 2010 audit and the questions described demographics, education, career experience and
trajectories and current employment in nutrition and dietetics. The demographic data suggested
respondents were a median age of 27 years; 90% were female and 8% male; 71% reported to be Caucasian,
8% Hispanic, 5% African American and 9% Asian. Career directions included 47% of the Non-RDN BS/DPD
Grads had unsuccessfully applied for an internship. One third (34%) reported that they intended to apply
for admission within the next 12 months and 29% stated that they might apply for admission later; 18%
reported that they had no plans to pursue an internship. The most common employment positions
identified were in clinical and community settings with the primary areas of practice being nutrition care
and counseling, education and food service. Results suggested few differences in the nutrition and dietetics
practice for Non-RDN BS/DPD Graduates and EL DTRs previously measured by the 2010 DTR Practice Audit
Committee5.
Council on Future Practice Visioning Report
In 2006, an American Dietetic Association Education Task Force noted that basic educational requirements,
consisting of a bachelor’s degree and supervised practice, have not changed since 1927 and recommended
a review of the educational competencies to allow more opportunity to meet future practice needs through
all degree levels6. The Council on Future Practice (CFP) was created and has worked collaboratively with
the CDR and ACEND to project and plan for the future practice needs of the profession of nutrition and
dietetics.
In 2012, the Academy of Nutrition and Dietetics (Academy) CFP released a visioning document
recommending that the level of educational preparation for dietitians be elevated to a graduate level to
provide a greater depth of knowledge and skills needed for future practice in the profession. The document
made the following nine recommendations to support and advance future dietetics practice and keep the
Academy and its members at the forefront of food, nutrition and dietetics6.
1. Elevate the educational preparation for the future entry level RDN to a minimum of a graduate
degree from an ACEND-accredited program.
2. Recommend that ACEND require an ACEND-accredited graduate degree program and/or
consortium that integrates both the academic coursework and supervised practice components
into a seamless (1-step) program as a requirement to obtain the future entry level RDN credential.
Create an educational system for the future entry level RDN based on core competencies, which
provides greater depth in knowledge and skills that build on the undergraduate curriculum and
includes an emphasis area (clinical, management, community/public health).
3. Support the development and implementation of a new credential and examination for bachelor’s
degree graduates who have met DPD requirements. The competencies, skills and educational
standards should clearly differentiate between the practice roles of individuals with the new
credential and current/future graduate degree–prepared RDNs and provide minimal overlap
between the two. Additionally, legislative and regulatory issues (state and federal) will concurrently
16
be examined and a strategy will be designed to address potential unintended consequences of
developing a new credential for licensure and Centers for Medicare and Medicaid Services (CMS)
reimbursement.
4. Currently-credentialed DTR practitioners will continue to be supported and recertified; DT
education programs will continue to exist to meet the needs of the workforce in their local
communities and encourage transfer options with four-year institutions. A plan will be created for
all existing Dietetics Technician (DT) education programs and DTRs to promote the positive impact
of this transition for increasing workforce growth and opportunities.
5. Recommend that ACEND revise the undergraduate curriculum for dietetics education programs to
include requirements for practicum and diverse learning experiences outside of the classroom.
Develop students’ critical thinking, leadership, communication and management skills by providing
opportunities to experience them in the context of professional work settings.
6. Continue to support development of board certified specialist credentials in focus areas where
there is a reasonable pool of practitioners to justify the cost of development and maintenance of
the credential and develop a system to recognize RDNs practicing in focus areas where numbers
are too small to justify the financial investment.
7. Support continuing development of advanced practice credentials for the nutrition and dietetics
profession, based on objective evidence and continue to encourage and develop advanced
practice educational experiences and opportunities.
8. Conduct a well–funded, comprehensive marketing, branding and strategic communications
campaign related to all of the recommended changes targeting both internal and external
stakeholders.
9. Support a RDN credential name change that will be reflective of the changes outlined previously
and align with the name change of the Academy. The current RDN credential will remain intact and
the terminology used for the new credential titles for the RDN and the new credential for the
bachelor’s degree graduate who has met DPD requirements will be complementary and
coordinated to provide clarity in distinctions between the two credentials. Legislative and
regulatory issues (state and federal) will be examined concurrently and a strategy will be designed
to address potential unintended consequences of changing the name of the RDN credential for
licensure and CMS reimbursement.
17
SCOPE OF NUTRITION AND DIETETICS PRACTICE
RDN and DTR Scope of Practice
Scope of practice refers to a range of roles, activities and regulations within the nutrition and dietetics
performance arena7, 8. The concept of the dietetics scope of practice encompasses practice standards,
credentials, education, practice resources and practice management and advancement. A 2005 Federation
of State Medical Boards report defined scope of practice as the “definition of the rules, the regulations and
the boundaries within which a fully qualified practitioner with substantial and appropriate training,
knowledge and experience may practice in a field of medicine or surgery, or other specifically defined field.
Such practice is also governed by requirements for continuing education and professional accountability9.”
Scope of practice should require licensees to demonstrate that they have the requisite training and
competence to provide a service9.
The scope of practice for the RDN7 focuses on “food and nutrition and related services developed, directed
and provided by RDNs to protect the public, community and populations; enhance the health and wellbeing of patients/clients; and deliver quality products, programs and services, including Medical Nutrition
Therapy (MNT), across all focus areas. Focus areas include, but are not limited to, oncology, pediatrics,
diabetes, nephrology, sports, nutrition support, extended care, corrections, weight management and
obesity, wellness and prevention, behavioral health, eating disorders and disordered eating, intellectual
and developmental disabilities, mental illness, addictions, integrative and functional medicine, food and
culinary and supermarkets, sustainable resilient healthy food and water systems, communities and public
health, education and management.” RDNs perform their roles in a variety of practice settings including
acute, ambulatory/outpatient, home care and extended health care; business and communications;
community and public health; entrepreneurial and private practice; foodservice systems; integrative and
functional medicine; management and leadership; military service; nutrition informatics; preventive care,
wellness and weight management; research; school nutrition; sports nutrition; sustainable resilient healthy
food and water systems, U.S. public health service and universities and other academic settings.
The scope of practice for the DTR8 focuses on “food and nutrition and related services provided by DTRs
who work under the supervision of an RDN when in direct patient/client nutrition care and who may work
independently in providing general nutrition education to healthy populations, consulting to foodservice
business and industry, conducting nutrient analysis, data collection and research and managing food and
nutrition services in a variety of settings.” DTRs perform their roles in a variety of practice settings
including acute, ambulatory/outpatient and extended health care; business and communications;
community and public health; entrepreneurial and private practice; foodservice systems; management and
leadership; nutrition informatics; preventive care, wellness and weight management; research; school
nutrition; sports nutrition; sustainable resilient healthy food and water systems and universities and other
academic settings.
More recently health promotion and disease prevention and public policy and advocacy have been
highlighted for future growth and focus10-14. The world population is expected to be greater than nine
billion by the year 2050. Concentrated attention is on sustainability and protection of natural resources to
ensure safe and healthy food and water. This new practice area for future nutrition and dietetics
professionals will require focused knowledge, skills, systems thinking and experience in policy, system and
environmental change strategies addressing quality, quantity and safety on human, environmental,
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economic and social health10.
Regulation of Scope of Practice
The purpose of scope of practice regulation is for public protection and safety which should be evaluated
as most important in scope of practice decisions, rather than professional self-interest. Changes in scope of
practice are inherent in a changing health care system. Accrediting and regulatory bodies routinely assess if
the current scope of practice accurately reflects nutrition and dietetics professionals’ current activities,
functions, roles and responsibilities. The Institute of Medicine (IOM) Center for Health Workforce Scope of
Practice and the Future of Team Based Care has recommended that future changes in scope of practice
will need to first have a foundational basis within four areas: an established history of the practice scope
within the profession, education and training, supportive evidence and appropriate regulatory
environment15.
State dietetics licensing boards are the groups responsible for developing and implementing individual
state statutes and regulations. Each state defines their RDN practitioner’s scope of practice from
educational preparation to restriction of performance. For the 46 states that require RDN licensing, the
majority of states declare a minimum of the following statutes in their scope of practice: specifications of
educational preparation; practice of medical nutrition therapy including nutrition assessment,
establishment of nutritional care plans and development of nutritional related priorities, goals and
objectives; and provision of nutrition counseling or education as components of preventive and restorative
health care (see Appendix B).
Expanding Scope of RDN Practice
Expanding Scope of Practice in U.S.. As a result of a 2014 Centers of Medicare and Medicaid Services
ruling, RDNs may write diet orders for modified diets and medical nutrition therapy including vitamin and
mineral supplementation, enteral nutrition and parenteral nutrition and can order nutritional laboratory
tests16. The complex knowledge of pharmacotherapy is needed to carefully select and time medical
nutrition therapy in patients also receiving medication therapy.
Martin and Lipman estimated by the year 2050 33% of the U.S. population will have diabetes mellitus17.
Due to the predicted increase in diabetes and the changing health care models, RDNs will be increasingly
called upon to provide services as a level 3 educator (uncertified educator of Diabetes Self-Management
Education Provider - Four Levels) and DTRs will serve as level 2 educators. The emergence of nontraditional settings will require nutrition and dietetics positions to work in community health centers, faithbased institutions, public libraries, retail pharmacy clinics, congregate housing for the elderly, nephrology
clinics, bariatric surgery practices, patient-centered medical homes, nurse-managed health centers,
community nursing centers, telehealth, worksites, schools and diabetes-related companies.
Concurrently, the U.S. Bureau of Labor Statistics (2010) has projected a significant growth in demand for
diabetes educators due to an expansion of federally qualified health centers and other community health
centers from the Patient Protection and Affordable Care Act. Little work has been done at present on state
licensure of diabetes educators and they are classified as ‘health educators’ because there is no standard
job classification by the U.S. government17.
Expanding Scope of Practice in Canada. An example of proposed significant changes in RDN scope of
practice can be seen from The College of Dietitians of Ontario and Dietitians of Canada 2008 Application
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for Review of the Scope of Practice of Dietetics in Ontario18. The document proposed many changes to the
scope of practice for dietitians including the ability to prescribe and manage therapeutic diets and enteral
and parenteral nutrition; make adjustments to the dose of existing insulin or oral hypoglycemic
medications that have been prescribed by a physician or authorized health care practitioner; order
specified tests as prescribed in the regulation, within their scope of practice and limited to those of
particular relevance to managing nutrition therapy; perform skin pricks for the purpose of monitoring
capillary blood levels; and act as an “evaluator” for the purpose of determining capacity for admission to a
long term care (LTC) facility.
FUTURE NEEDS IN HEALTH CARE EDUCATION
The Institute of Medicine (IOM)
Core Competencies. After releasing two IOM reports on safety and quality19, 20, the IOM sponsored a
second summit on health professions education. Attendees at the summit identified five competencies
central to the education of all health professions for the future. The IOM then recommended these as core
competencies for all health care professionals; they include: provide patient-centered care, work in
interdisciplinary teams; provide evidence-based practice; apply quality improvement; and utilize
informatics21. The IOM stressed that these core competencies would create an outcome-based education
system that better prepares practitioners to meet the needs of patients and the requirements of a
changing health care system.
Aims of Care. The IOM Crossing the Quality Chasm22, discussed concerns that health care harms too often
and more often than not is unsuccessful in delivering its potential benefits. The reports highlighted
numerous changes that are affecting health care delivery and suggest a shift from acute to chronic care.
The report stressed the need to integrate a continually expanding evidence base and technological
innovations, provide more clinical practice occurring in teams, prepare practitioners to work in complex
delivery arrangements and change patient–clinician relationships. The report suggested six ‘aims’ of care:
Safe Care by avoiding injuries to patients, Effective Care by providing care based on scientific knowledge,
Patient-centered care by providing respectful and responsive care that ensures that patient values guide
clinical decisions, Timely care by reducing waits for both recipients and providers of care, Efficient care by
avoiding waste and Equitable care by ensuring that the quality of care does not vary because of
characteristics such as gender, ethnicity, socioeconomic status or geographic location22.
Global Forum on Innovation in Health Professional Education. A 2012 IOM initiative activity, The Global
Forum on Innovation in Health Professional Education23 brought together stakeholders from multiple
countries and professors to discuss within health professional education. Three publications resulted from
the forum, Interprofessional Education for Collaboration: Learning How to Improve Health from
Interprofessional Models across the Continuum of Education to Practice – Workshop Summary24,
Establishing Transdisciplinary Professionalism for Improving Health Outcomes - Workshop Summary25 and
Assessing Health Professional Education – A Bridge to Quality21. The third report highlights the importance
of matching professional competency appropriately with the health care task to obtain a maximum return
on investment and patient safety. The health care workforce has produced systems of higher education in
the U.S. and elsewhere that has not been adequately aligned with the mix of professionals required to
reach comprehensive health care goals effectively. This lack of alignment in workforce planning partly
20
stems from historic reasons (political and bureaucratic), partly from hardened attitudes regarding
professional roles and from vested interests that resist change. Health care reform in all health systems
requires progression towards the most efficient and collaborative staffing models.
There is a great deal of merit in fostering this progress in a coordinated and efficient manner to achieve
desirable levels of standardization. The eight IOM reports emphasized the growing need for leadership and
teamwork competencies, skill sets that are relevant to all high, middle and low-income countries19-25.
Interprofessional Education. Interprofessional education (IPE) is increasingly viewed as an important
strategy to address health workforce reform and safety and quality issues26, 27. According to the World
Health Organization (WHO), IPE is an experience that “occurs when students from two or more professions
learn about, from and with each other”28. The IOM’s Future Practice Educational Recommendations21
suggest that learning experiences need to provide students the opportunity to design and measure care
such as structure, process and outcomes. Academic and supervised learning experiences need to increase
student understanding of improving quality as a vital core value of all health professions19.
Learning in groups is not the same as learning interprofessionally. According to the IOM27, more IPE
education is needed than IPE courses and continuing professional development. Interprofessional Practicebased (IPP) learning experiences are crucial for enhancing collaborative competencies 27.
Students adopt interprofessional theories and values through experiential learning with well-functioning
teams. Additionally, IPE helps students appreciate other professionals, avoid developing negative
stereotypes, prevent working in silos and ultimately improve patient care.
The provision of coordinated care through an interdisciplinary health care team has been shown to deliver
safer, more cost-effective, more efficient and higher benefit to patient/client treatment than individual
professionals28. Well-functioning teams share qualities such as understanding of the team’s goals and his
or her role within the team, mutual trust among team members. In order for health care professionals to
work interprofessionally, they must be educated interprofessionally28.
Lancet Commission
The Lancet Commission’s Health Professionals for a New Century: Transforming Education to Strengthen
Health Systems in an Interdependent World29 was written by the Lancet Commission, which included 20
professional and academic leaders from a multitude of countries who assembled to develop a common
strategy for postsecondary education in medicine, nursing and public health. One of the aims of the
commission was to develop a shared vision that was not restricted by borders or the silos (constraints) of
individual health professions. The Commission reported that current gaps and inequities in health and
health care continue both within and between countries and demonstrate the failure to deliver health
advances equitably. Health professional education has not kept up or been able to meet these challenges,
largely because of fragmented, outdated and static curricula that produce unprepared graduates. The
identified problems were systemic and included29 a mismatch of professional competencies to patient and
population priorities because of fragmentary, outdated and static curricula producing ill-equipped
graduates from underfinanced institutions. In almost all countries, the education of health professionals
has failed to overcome dysfunctional and inequitable health systems because of curricula rigidities,
professional silos, static pedagogy, insufficient modification to local conditions and commercialism in the
professions. For example, there is a predominant hospital emphasis at the sacrifice of primary care, in both
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poor and rich countries and failure to share the dramatic health advances equitably. The Commission’s
goal was for “all health professionals in all countries needing to be educated to mobilize knowledge and to
engage in critical reasoning and ethical conduct so that they are competent to participate in patient and
population-centered health systems as members of locally responsive and globally connected teams”29.
The Commission emphasized that instructional and institutional modifications are needed with the
following two outcomes in mind: transformative learning and positive interdependence in education.
Informative learning is about acquiring knowledge and skills in order to produce experts. Formative
learning is about socializing students around values with its function to produce professionals.
Transformative learning is about developing leadership attributes; its purpose is to produce enlightened
change agents. Positive interdependence is when team members need each other to succeed via learning
goals, product goals, rewards, resources, tasks or roles. Positive independence occurs with face-to-face
affirmative interactions between group members. Effective education builds each level upon the previous
one. As a valued outcome, transformative learning involves three fundamental shifts: from fact
memorization to searching, analysis and synthesis of information for decision making; from seeking
professional credentials to achieving core competencies for effective teamwork in health systems; and
from non-critical adoption of educational models to creative adaptation of global resources to address
local priorities.
Transformative learning is the proposed outcome of instructional reforms; interdependence in education
should result from institutional reforms30. Specific recommendations by the Commission to improve
systems performance were divided into instructional reforms and institutional reforms. The Commission
report recommended instructional and institutional improvements in education in order to produce the
desired outcomes of transformative learning and interdependence. The instructional improvements
included: adopt competency-driven approaches to instructional design; adapt these competencies to
rapidly changing local conditions drawing on global resources; promote interprofessional and
transprofessional education that breaks down professional silos while enhancing collaborative and nonhierarchical relationships in effective teams; exploit the power of information technology for learning;
strengthen educational resources, with special emphasis on faculty development; and promote a new
professionalism that uses competencies as objective criteria for classification of health professionals and
that develops a common set of values around social accountability 32. The Commission’s recommendations
for institutional improvements included: establish in every country, a joint education and health planning
mechanism that take into account crucial dimensions of the health workforce, such as social origin, age
distribution and gender composition; expand academic centers to academic systems encompassing
networks of hospitals and primary care units; link together through global networks, alliances and
consortia; and nurture a culture of critical inquiry32.
22
Integrative Health Care and Integrative Medicine
Integrative health care, often referred to as interprofessional health care, is an approach characterized by
a high degree of collaboration and communication among health professionals26. The sharing of
information among team members related to patient care and the establishment of a comprehensive
treatment plan to address the biological, psychological and social needs of the patient is what makes
integrated health care unique.
As interest in integrative health care and the use of complementary and alternative therapies by the public
continues to grow, concern has increased as to whether health professionals are sufficiently educated
about integrative health so that they can safely and effectively care for patients. Integrative health topics
recommended include relationship-based care, whole person care (i.e., mind, body and spirit),
complementary and alternative medicine (CAM) and self-care. As a result, the 2005 IOM Committee on
CAM recommended that all conventional health professions training programs incorporate sufficient
information about CAM into the standard curriculum to enable licensed professionals to competently
advise their patients about CAM30.
The Bravewell Collaborative, a philanthropic organization that works to improve health care, defined
integrative medicine as “an approach to care that puts the patient at the center and addresses the full
range of physical, emotional, mental, social, spiritual and environmental influences that affect a person’s
health. 31” The Bravewell Collaborative identified integrative medicine as having the following
characteristics31: the patient and practitioner are partners in the healing process; all factors that influence
health, wellness and disease are taken into consideration; the care addresses the whole person, including
body, mind and spirit in the context of community; practitioners use all appropriate healing sciences to
facilitate the body’s innate healing response; effective interventions that are natural and less invasive are
used whenever possible; because good medicine is based in good science, integrative medicine is inquiry
driven and open to new models of care; alongside the concept of treatment, the broader concepts of
health promotion and the prevention of illness are paramount; care is individualized to best address the
person’s unique conditions, needs and circumstances; practitioners of integrative medicine exemplify its
principles and commit themselves to self-exploration and self- development.
The Consortium of Academic Health Centers for Integrative Medicine uses the following definition:
“Integrative medicine is the practice of medicine that reaffirms the importance of the relationship
between practitioner and patient, focuses on the whole person, is informed by evidence and makes use of
all appropriate therapeutic approaches, health care professionals and disciplines to achieve optimal health
and healing”32. Suggestion content on integrative medicine in health professional education includes:
patient-centered and whole person care; personal responsibility for health and wellness; lifestyle choices,
behaviors and outcomes including but not limited to diet, exercise and stress reduction; health promotion
and disease prevention; and knowledge, principles, practices and processes that facilitate the integration
of conventional biomedical care with CAM30-33.
23
New U.S. Population Concern - Young Adults
The needs of young adults and the challenges they face, do not receive a great deal of systematic attention
in policy and research. Accordingly, the Health Resources and Services Administration asked the Institute
of Medicine (IOM) to convene a committee to examine, analyze and synthesize information and knowledge
on the health, safety and well-being of young adults34. Young adults (18-26 years of age) today compared
to decades ago live in a more global and networked world, marked by increased knowledge and
information transfer, heightened risks, low social mobility and greater economic inequality. Young adults
are trapped between the exorbitant cost of college (many students have difficulty financing the investment
or repaying the debt they incur) and low prospects for well-paying jobs with only a high school diploma.
Young college graduates increasingly find it hard to find entry level jobs with an associate’s degree or
bachelor’s degree and more and more jobs have become part-time which does not help to pay back school
loans. Many companies do not provide health insurance or other non-salary benefits. Jobs that pay higher
wages require additional knowledge, skills and experience.
One key finding of the IOM committee’s work was that young adults were unhealthy in terms of diet and
physical activity; they pay less attention to health maintenance and mental/behavioral health and partake
in risky behaviors. The health status of young adults included a 23% obesity rate, 25% hypertension, 7%
diabetes and 27% with impaired glucose tolerance34. Examination of health indicators from Health People
2010 revealed a surprising pattern of declining health, seen most clearly in health behaviors and related
health statuses. As these individuals entered their early and mid-20s, they were less likely to exercise, eat
breakfast and get regular physical checkups and dental checkups and they were more likely to eat fast
food, contract sexually transmitted diseases, smoke cigarettes, binge drink and use marijuana and hard
drugs34. This committee cautioned that this poor young adult health status will negatively affect workforce
productivity, public safety, national security and the ability of the workforce to compete on a global level.
For example, 12% of all age-eligible men and 35% of all age- eligible women were unable to meet U.S.
Army standards for weight-to-height ratio and percent body fat in 2007-200834. The Department of Defense
reported that, between 2006 and 2011, 62,000 individuals who arrived for military training failed their
entrance physical because of their weight.
The IOM committee recommendations focused in three common themes: current policies and programs
addressing education and employment, civic engagement and national service, public health, health care
systems and government programs are fragmented and uncoordinated; current policies and
programs
are not focused on specific developmental needs of this population; and there is limited evidence-based
data for young adults on effective interventions, policies, programs and service designs34. Knowledge of
the use and delivery of preventive services for young adults is limited by the lack of attention to this age
group in clinical delivery systems and health services research, programs and education. Coordination is
needed between the private and public sector to bring forward public awareness and effort towards
prevention. Nutrition and dietetics curricula will need to increase content and skill development in
prevention and treatment services for young adults.
24
EXTERNAL FORCES IMPACTING HEALTH CARE EDUCATION
Education Accreditation
The role of accreditation is to assure quality, provide access to federal funds, generate public confidence in
higher education and ease transfer of credit. Accreditation in the United States is undergoing a major
change as governmental regulatory authority to judge quality in higher education expands, eclipsing
accreditation’s collegial model of quality review. The enormous growth of public and private money in
higher education, the commitment to universal access and the accompanying calls for greater public
accountability, the growing nationalization of public policy and the impact of electronic technology have all
contributed to this change. From the 2011 IOM report on Scope of Practice and Future Team Based Care,
accreditors will continue to influence proactive quality improvement (QI) and act as change agents15.
Accreditors will be required to work more closely with the U.S. Department of Education (USDE)
(www.ed.gov) due to increased public demand for accountability and student performance. Accrediting
organizations are required to meet ten recognition standards that are in federal law. These standards cover
student achievement, curriculum, faculty, student support services and financial and administrative
capacity. Accrediting organizations are also expected to comply with a broad collection of rules and
regulations that accompany the standards such as:

Rule 602.16: Accreditation agency standards must address the quality of institutions or programs in
multiple areas including “success with respect to student achievement in relation to the
institution’s mission, including an appropriate consideration of course completion, state licensing
examination and job placement rates.”

Rule 602.21 requires that a recognized accreditation agency “maintain a systematic program of
review that demonstrates that its standards are adequate to evaluate the quality of the education
or training provided by the institution and program it accredits and is relevant to the education or
training needs of students.”
Based upon the recommendations from the 2014 IOM report for Assessing Health Professional Education,
nutrition and dietetics students may be required by the nutrition and dietetics accrediting body to receive
novice and advanced education in IPE in order to develop competencies and skills needed to function as a
valued member of the health care team17. Part of the educational requirements likely will include IPP
learning experiences24.
Degree Qualifications Profiles
Accreditors may be required to implement degree qualification profiles (DQP) which are delineations of
knowledge and skills between degrees such as IPE differences for bachelor’s and master’s prepared
students35. The DQP attempts to establish specific learning expectations for graduates receiving a
particular degree. The Profile proposes sets of competencies in five areas of student learning: specialized
knowledge, broad integrative knowledge, intellectual skills, applied learning and civic learning and
addresses three degree levels: associate, bachelor and master’s. At each degree level, the competencies
themselves are described in terms of “action verbs” that portray what a student at that level can actually
do. For example, competencies at the associate’s level may require students to “describe” or “present” a
topic, at the bachelor’s level to “construct” or “explain” something and at the master’s level to “create” or
“assess” something. A degree qualifications profile is a set of requirements of what students should be
25
expected to know and be able to do as a benchmark for the associate, bachelor’s or master’s degree
through specific learning outcomes35. Degree profiles are especially important today because jobs are
rapidly changing and use technologies that are still emerging and increasing in complexity and graduates
work with colleagues from (and often in) all parts of the globe. The resulting product, a degree profile,
includes defined competencies which highlight cumulative integration of learning from a multitude of
resources and application of learning from a variety of settings35.
Professional Maturation
The medical and educational landscapes have changed greatly and continue to change. Over that time, the
practice of medicine has become increasingly complex in three main areas: new knowledge (e.g., genetics
and implications for therapy, bioterrorism); new skills (e.g., use of information and medical technology,
review and analysis of the medical literature and application of the findings to practice; and professional
attitudes, which are taking on greater importance in ensuring public trust in medical professionals. These
increasing complexities have mandated curriculum reform and the development of objective assessment
tools to measure student knowledge, skills and attitudes, as well as the need to prepare students to be
self-directed critical thinkers who can adapt to changes in the field. The analytical and critical thinking skills
required to negotiate this new medical landscape are traditionally associated with a graduate level of
education.
Health professions that have recently increased degree requirements include Audiology (Doctorate),
Occupational Therapy (Master’s), Pharmacy (Doctorate), Physical Therapy (Master’s/Doctorate) and
Physician Assistant (Master’s) 36-39. Still other health professions are considering increased degree
requirements, such as Dental Hygiene40. Professional degree maturation requires examination of the
incentive for advancing the entry level degree requirement. The necessity should stem from a mixture of
data to demonstrate the demands for increased educational and skill requirements of the profession,
patient and public safety as well as increased access for patients and increased recognition of the
profession. When evaluating higher education for entry level practice it should consist of a review of data
and evidence to support increased educational levels, assess educational preparation and performance
abilities and requirements, assess job demands and requirements as prescribed by health care facilities,
determine demographic characteristics of health professionals at various degree levels, consider career
pathways and expanded functions gained through educational and practical experience such as
transitional degrees41.
Careful consideration should be taken when evaluating the impact and success of implementing a new
advanced degree requirement. Potential negative impacts from a degree creep could be exacerbation of
workforce shortages, lack of capacity in colleges in universities (faculty, facilities, funds, clinical sites), lack
of credentialed faculty to deliver instruction, decrease in workforce diversity as inaccessible to minorities
and economically disadvantaged, increase in tuition, increase in time in college and access to health care
limited in rural areas. Another concern to mitigate may be the creation of a decline in job satisfaction and
morale if advanced skills and knowledge are underutilized42.
26
External Drivers of Safety and Quality
As nutrition regulations and legislation change, RDNs and the dietetics education and training process will
need to adapt and requirements of external accrediting bodies will need to reassess proficiency and
educational requirements. The changing focus of many government agencies is enhancing the practice of
dietetics in many areas.
Health Care Accreditation. The Joint Commission health care accreditation, certification and standards
manuals for organizations such as hospital, behavior health, long-term care/assisted living demonstrate the
paradigm shift from department policies and procedures to an organizational focus on patient safety goals
and elements of performance and moving from survey ready to continuous standard compliance. The
Provision of Care, Treatment and Services standards are collaborative and interdisciplinary and require
RDNs to take a proactive leadership role on committees and focus on improving the safety and quality of
care provided (www.jointcommission.org). Like The Joint Commission, DNV-GL Health Care is a Center of
Medicare and Medicaid Services (CMS) authorized accrediting organization for acute care hospitals. The
purpose of these organizations is to manage risk and improve patient safety, quality and overall health
care delivery.
United States Department of Health and Human Services (DHHS). The DHHS Strategic Plan includes
strategic goals and associated objectives, strategies for FY 2014-2018 to include: strengthen health care;
advance the health, safety and well-being of the American people; and ensure efficiency, transparency,
accountability and effectiveness of HHS programs43. Nutrition and dietetics practitioners will be involved in
the strategic initiatives by promoting a high value, safe and effective health care practice, implementing a
21st century food safety system, promotion of prevention and wellness across the lifespan, achieving and
maintaining healthy weight for Americans and fostering a 21st century health workforce.
Cooperative Extension System. The Nation’s Cooperative Extension System created a program focus in
health and wellness, which is aligned with the U.S. Department of Health & Human Services’ National
Prevention Strategy: Strategic Directions and the National Prevention Strategy. The Cooperative Extension
program brings a multitude of assets to the partners (university system, health professionals, education,
private and public sectors, engaged communities, community organizations and clinical and community
preventative services). Additionally, Cooperative Extension has developed core themes to guide the
Extension Health Task Force Recommendations that include: strengthen organizational functioning;
enhance leadership and professional development; increase strategic marketing and communications; and
build partnerships and acquire resources for health44. Nutrition and dietetics practitioners will be able to
both serve the strategy initiatives and benefit from core theme developments.
U.S. Preventive Services Task Force. The U.S. Preventive Services Task Force (USPSTF) recommendations to
Promote a Healthy Diet and Physical Activity for Cardiovascular Disease (CVD) Prevention in Adults with
Known Risk Factors- Behavioral Counseling are to provide screening at the primary, secondary and tertiary
levels of health care on all at-risk adults for obesity and provide comprehensive weight loss and behavior
management by qualified professionals naming the primary care provider and the RDN12-14.
National Prevention Strategy. The National Prevention Strategy is supported by the Affordable Care Act. It
represents a shift in health care from problem-based medicine to prevention and wellness endorsed by the
U.S. legislature and the Surgeon General. The National Prevention Strategy’s vision is to improve the
27
health and quality of life for individuals, families and communities by moving the nation from a focus on
sickness and disease to one based on prevention and wellness45. The healthy eating and active living
strategic priorities involve and need leadership from nutrition and dietetics practitioners. Healthy eating
includes increasing access to healthy and affordable foods in communities; implementing organizational
and programmatic nutrition standards and policies; improving nutritional quality of the food supply;
helping people recognize and make healthy food and beverage choices; supporting policies and programs
that promote breastfeeding; and enhancing food safety. Active living comprises RDN involvement in
conducting physical activity assessments, providing counseling and referring patients to allied health care
or health and fitness professionals; offering low or no-cost physical activity programs; developing and
instituting policies and joint use agreements that address liability concerns and encouraging shared use of
physical activity facilities (e.g., school gymnasiums and community recreation centers); and offering
opportunities for physical activity across the lifespan.
Centers of Medicare and Medicaid Services. Medical nutrition therapy (MNT) services may be provided
under Medicare Part B (Medical Insurance)46, 47. A registered dietitian or nutrition professional who meets
certain requirements can provide these services, which may include nutritional assessment, one- on-one
counseling and therapy services through an interactive telecommunications system. Coverage is provided
for patients/clients with diabetes, renal disease, on dialysis, who have had a renal transplant within the
last 36 months and other physician/health care provider referrals. As the Affordable Care Act continues to
unfold and its emphasis on preventative services and management of chronic diseases the number of CMS
covered services is expected to continue to grow.
As part of a large recent ruling (July 2014) by CMS, qualified dietitians or qualified nutrition professionals
will be explicitly permitted to become privileged by the hospital staff to order patient diets, order lab tests
to monitor the effectiveness of dietary plans and orders and make subsequent modifications to those diets
based on the lab tests, if in accordance with state laws including scope of practice laws48. In order for
patients to have access to the timely nutritional care that can be provided by RDNs, a hospital must have
the regulatory flexibility either to appoint RDNs to the medical staff and grant them specific nutritional
ordering privileges or to authorize the ordering privileges without appointment to the medical staff47. The
rule is a first step toward positioning RDNs in the care coordination environment to ensure nutrition is an
essential component of client/patient/customer transitions of care49, 50.
Physician Compare is a CMS website that helps participants find and choose physicians and other health
care professionals enrolled in Medicare as part of the Affordable Care Act51. In the future as the ‘over 65’
population increases and health care shifts to keep seniors at home, RDNs may increase the volume of
home visits to provide their patients’ nutritional care.
Changes are occurring in our health care payment systems that will directly impact MNT, nutrition services
and the business of dietetics across practice settings52. Transformations in the payment systems include
bundled payments or global payments, pay-for-performance, value-based purchasing, hospital
readmissions reduction programs and hospital-acquired conditions (HAC). "Pay-for-performance" is an
umbrella term for initiatives aimed at improving the quality, efficiency and overall value of health care53.
These arrangements provide financial incentives to hospitals, physicians and other health care providers in
the private and public sectors to carry out such improvements and achieve optimal outcomes for patients.
The Affordable Care Act expands the use of pay-for-performance approaches in Medicare and encourages
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research to identify designs and programs that are most effective. The typical pay-for- performance
program provides a bonus to health care providers if they meet or exceed agreed-upon quality or
performance measures, such as reductions in hemoglobin A1c in diabetic patients. The programs may also
reward improvement in performance over time, such as year-to-year decreases in the rate of avoidable
hospital readmissions. Pay-for-performance programs can also impose financial penalties on providers that
fail to achieve specified goals or cost savings. For example, the Medicare program no longer pays hospitals
to treat patients who acquire certain preventable conditions during their hospital stay. RDNs have the
expertise and skill set to establish improvement in specific health care quality issues. The challenge will be
to demonstrate evidence-based MNT outcomes and cost- effectiveness on a broad scale.
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KNOWLEDGE AND SKILLS NEEDED FOR FUTURE NUTRITION AND DIETETIC PRACTICE
There is a need to fill the gap relating to health promotion, heath coaching, wellness, and public health
nutrition. These skills will be beneficial as RDNs address issues related to client/patient compliance with
MNT and health promoting lifestyle behaviors. Motivational interviewing to influence and sustain behavior
change skills is critical in practice and research in the area of behavior change skills is needed.
Nutritional Genomics
The advancement of genomics is progressing at a swift pace. Nutritional genomics is a component of
genomics and includes nutrigenomics, nutrigenetics and nutritional epigenomics. ‘Personalized nutrition’
has been earmarked by the Academy as future opportunities for RDN, however, specialized knowledge and
training will be required4. RDNs using nutritional genomics in clinical practice will demand a full
understanding, interpretation and communication of complex genetic testing results as a tool to assess the
risk of a disease54. Currently RDNs are not trained in clinical genetics and molecular testing. RDNs surveyed
in the U.S., Canada and the U.K. over the past ten years have consistently revealed that RDNs are not
confident in their knowledge of translating genomic science into clinical practice and limited ability to
communicate probability and risk of disease from genetic testing54-58.
Behavioral Counseling, Coaching, Coordination of Care and Program Planning and Evaluation
The U.S. Preventive Services Task Force (USPSTF) has recommended intensive, behavioral dietary
counseling for adult patients with hyperlipidemia and other known risk factors for cardiovascular and dietrelated chronic disease11-14. Intensive counseling can be delivered by nutrition and dietetics practitioners.
Expansion of scope of nutrition and dietetics practice into behavioral counseling suggests a need for
increased skills in the areas of coaching, motivational interviewing, coordination of care and program
planning and evaluation. RDNs will positively impact the prevention and treatment of co- morbid
conditions and chronic diseases. Besides changing practice, health care settings for counseling, coaching
and care coordination are changing shown by the increase in home care and in the evolution of the
patient-centered medical home. RDNs will need to adapt to these changes and forge the frontier to be
successful59-63.
Changes affecting health care delivery are occurring, including a shift from acute to chronic care, the need
to integrate a continually expanding evidence base and technological innovations, more clinical practice
occurring in teams, complex delivery arrangements and changing patient–clinician relationships59-63.
Informatics
The Academy recently outlined informatics Skills Specific to Levels of Dietetics Practice64. The term
informatics is used to describe how humans find, store, analyze and manage information. For entry level
competence, minimum basic computer and information literacy skills should be: demonstrate principles of
computer file organization including information storage, data protection (backing up data) and basic
computer skills; demonstrate basic proficiency with use of selected operating systems (e.g., Mac OS,
Windows, Linux); use basic software applications to create documents, spreadsheets and presentations;
access and use a web browser to find information; demonstrate proper use of email, including sending,
receiving, forwarding, storing and attachments and proper use of email etiquette; quickly identify,
evaluate and disseminate accurate information to consumers and other health care professionals; manage
user security to protect patient/client information; retrieve a reasonable number of relevant documents
30
using PubMed to search the Medline database; find and evaluate online information sources using
appropriate search engines; understand appropriate use of social media tools; and be familiar with basic
functions of clinical information systems (e.g., computerized provider order entry, results reporting,
documentation and report generation) 64.
Telenutrition
According to the IOM’s 2012 Workshop summary on The Role of Telehealth in an Evolving Health Care
Environment, social media and social networking are the most prevalent online activities, have increased in
the elderly since 2010 and participation of all ages are expected to continue to grow65. These technologies
are already being used in health care for numerous functions. The entry level RDN will need to keep abreast
of the new technologies as well as keep up with their professional, personal, legal and ethical
responsibilities related to providing telehealth. Responsibilities include digital competence, regulatory
requirements and privacy laws to name a few66.
Teledietetics encompasses telephone consultation through dietitian call centers as well as the use of other
electronic modalities, such as interactive website tools that support knowledge and behavior change (e.g.
dietary assessment tools), social networking, video-based applications (e.g. online learning
modules/classrooms/webcast, educational videos), smartphone texting and applications and e-mail
messaging. Teledietetics services may involve client-professional (e.g. individual consultations, group
education) or professional-professional contact (e.g. support to health professionals)66. A variety of
nutritional care and health promotion activities may be provided through teledietetics communication,
including interventions (such as education, advice and reminders) and monitoring of interventions.
The Health Resources and Services Administration (HRSA) has asked the IOM to focus on the potential for
telehealth to serve geographically isolated individuals and extend the reach of scarce resources while also
emphasizing the quality and value in the delivery of health care services65. In the health care continuum, it
is proposed that telehealth be used for health promotion and disease prevention, for acute care and for
chronic disease management. Behavioral patterns and lifestyle choices have some of the largest impacts
on health and premature death. Most health care is self-care and the individual patient is the biggest
untapped resource in health care. However, the current system does not activate individuals to change
their behaviors. The IOM report states that as the baby boomers begin to retire and attempt to maintain
independent living in affordable and possibly more rural areas, telehealth will only continue to grow65. One
such model includes TREAT (Telemedicine for Reach, Education, Access and Treatment) which uses
telemedicine provided by an endocrinologist from an urban setting and a diabetes educator in a rural area
working with patients and their primary care providers67.
Currently, the RDN is named as a ‘Distance Site Practitioner’ under the Center for Medicare and Medicaid
Services69. The Medicare Part B program allows several services provided by RDNs and nutrition
professionals to be offered via telehealth68, 69. However, according to a 2009 Medicare claim review,
growth in adoption of telehealth among providers has been modest despite increases in Medicare
payment rates for telehealth services, expansions of covered services, reductions in provider requirements
and provisions of federal grants to encourage telehealth. There were no RDN-submitted claims for this
cross-sectional review70.
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Systems Thinking Knowledge and Experience
Systems thinking refers to the understanding of and ability to plan, implement, evaluate and develop
policy for health care systems involving food and/or nutrition and food systems and their global impact on
local and national issues. Systems thinking includes processes, sets of skills and technologies. The systems
thinking process applies a scientific method-based approach to building, communicating and applying
understanding to leadership decisions that cause many complex and unforeseen cascade of reactions. It is
vital for strategic planning. An example of a systems thinking learning experience includes the Sustainable
Food Lab which is a partnership among governments, NGOs and private sector organizations responsible
for the production and distribution of food around the globe. Their efforts are program-focused (e.g.,
coffee supply chain) and while working on any program, participants learn and apply systems thinking
concepts to develop deeper understanding of why the systems behave in ways they wish to change and
where leverage points are for improving that behavior71. Skills included are: skillful learning within
complex economic, social and environmental systems; acting effectively in change processes involving
multiple stakeholders with diverse goals and needs; and understanding webs of system’s interdependence.
According to Thornton, Peltier and Perreault, systems thinking is the ability to understand (and sometimes
predict) interactions and relationships in complex, dynamic systems use such concepts as continuous
incremental improvement, organizational learning and feedback loops72. Systems thinking assumes:
systems cause most of their problems; solutions lie within the systems; and systems cannot blame outside
circumstances for problems. Examples of systems thinking include: sustainable improvement in health
care; sustainable healthy eating environment to prevent obesity; systems thinking regarding obesity,
health care, food industry, marketing, economics and disability; and management of systems. Systems
thinking has also been applied to many other areas, such as sustainability, ecoliteracy, interdisciplinary
learning and obesity prevention and decision making72.
Management and Leadership
Management. Management in dietetics practice has been a ‘mega’ issue for the Academy for a number of
years73. RDNs in management positions continue to decrease and be the minority type of RDN jobs.
According to the 2013 Compensation and Benefits Survey, 24% of RDNs worked in inpatient acute-care
facilities, 12% in ambulatory/outpatient care facilities and 10% of RDNs worked in long-term, extended
care or assisted living facilities. These top three job settings employed approximately 50% of practicing
RDNs74. Twelve percent of practicing RDNs indicated their area of practice as food and nutrition
management. Supervisory responsibility has been found to be strongly associated with wage gains; those
with direct and/or indirect supervision of 100 or more employees had a median hourly wage 50% greater
than the typical RDN. Budgetary responsibility is also strongly correlated with hourly wages.
Educational competencies need to be revisited to promote management as a fundamental part of dietetics
curriculum and professional practice. The Academy has identified management competencies for dietitians
that work in food and nutrition services in health care. The following core competencies that directly
reflect food management and preparation are those competencies that a professional must be able to
master75, 76: manage change and transition; develop menus and foodservices that exceed customer
expectations; identify, develop and evaluate new business opportunities; lead teams of culturally diverse
members; incorporate new information technologies; ensure service of safe food to customers through
focus on Hazard Analysis Critical Control Points (HACCP); analyze and improve production and service
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processes through the application of appropriate operations management quantitative business analysis
techniques; measure customer satisfaction; accurately interpret data; make appropriate operational
changes; and lead in a constantly changing environment.
Management skills related to competencies for the role of a hospital foodservice director are specifically
needed in financial management, project management, strategic planning, marketing and human resource
management77-79. These same management skills are also vital in most other areas of dietetics. Critical
thinking, problem solving, strategic planning and emotional intelligence may be due to an inadequate or a
complete lack of experiential learning in undergraduate curricula21. Management is a group of skills, a
science, an art that is interconnected to every facet of nutrition and dietetics80.
Management is needed to be successful in research to plan the research budget and apply for grant
funding; in private practice to plan for income to offset expenses and non-reimbursement; for
interdisciplinary team function to use emotional intelligence and persuasion skills, in public health
nutrition and community nutrition to plan and evaluate programs; and in academics to establish return on
investment for the university to approve new curriculums to name a few81.
The 2006 Employer Qualitative Research Study surveyed the views of 140 employers of RDNs and DTRs
specifically on entry‐level practitioners. Employers mainly identified management skills as a weakness for
entry level RDNs (unpublished data). Employers emphasized the need for RDNs who are able to look at the
big picture and think strategically, run and justify programs, understand health care as a business, add
value and who are entrepreneurial. Employers wanted RDNs with the following skills and abilities: work in
a team; work across levels/departments in the organization (patients, doctors, nurses, technicians,
administrators, cooks); supervise and delegate; coach/mentor and negotiate. Skills were also needed in
accounting and finance; budget and cost control; inventory control; quality assurance and performance
improvement; marketing/selling; revenue generation; reimbursement and sales; research and grant
writing; forecasting future needs; problem solving and decision making; effective communications,
meeting management, strategic planning; marketing, human resources, and technology.
According to the most recent standards of performance for generalist and advanced RDNs in food and
nutrition systems82, RDNs must be able to demonstrate basic competencies in the following areas:
environmental protection rules; the political environment; marketing and customer satisfaction;
continuous quality improvement; work redesign and productivity; innovative cost-containing measures;
food consumption patterns; food and equipment technology; human resources trends; food and water
safety; disaster and emergency planning; project and process management; and cultural diversity in the
workplace82.
Leadership. Often RDNs are perceived as assisting in instead of leading the nutrition care process; a
perception which can hinder career advancement83. The profession must prepare for continued change in
the future by defining, recognizing and supporting multiple levels of practice in a variety of practice areas
to meet marketplace demands and to encounter ongoing constant change6. Specific leadership skills
needed in RDNs to be successful include collaboration via networking and the sharing of knowledge;
communication and mentoring; authentic leadership with emotional intelligence and feedback; vision
including keeping abreast of future trends; and innovation such as taking a risk and being creative83-86. The
changing landscape of the health care community further emphasizes that leadership skills are essential
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for RDN accomplishments and viability as well to spread nutrition messages, build brands and businesses,
communicate more effectively with employees and stakeholders, enhance the ‘bottom line’ and ultimately
improve nutrition service.
Case Management
The effectiveness of use of an RDN as a case manager was demonstrated in a randomized controlled trial
that compared usual medical care to usual care-plus-lifestyle case management provided by an RDN over a
one year period. The case-managed group showed substantially greater weight loss, reduced A1c values,
decreased prescription use and increased health-related quality of life87. Case management participants
had fewer inpatient admissions, which substantially lowered medical care costs. Providing medical
nutrition therapy to high-risk patients with type 2 diabetes and obesity decreased health plan costs by 34
percent88.
Coding, Coverage and Reimbursement for Nutrition Services
The results of the Academy’s 2013 Coding Survey indicated that respondents mainly used two of the five
MNT CPT codes (97802, 97803, 97804, G0270 and G0271)89. Those respondents not using any codes
(n=759 of the 3,182 respondent providers of outpatient MNT) cited reasons as they did not bill insurance
plans or some other group determined billing code. Regarding establishment of usual and customary fee
for nutrition services delivery, only 32% (n=1,006) answered they had and 44.5% (n=1,402) specified that
they did not know89. The authors concluded that RDNs have a limited knowledge of basic practice and
management concepts. Additional education is needed in order to improve third party payment for
nutrition services through provider training on coding, billing, documentation of initial and sustained
efficacy from nutrition services and skills to market efficacy outcomes to private payers to justify and
expand coverage of MNT services. One of the concerns in the survey observed by the authors was the
increasing trend in the number of RDNs who reported not billing insurance plans and using “self-pay
only89.” This type of practice limits access to the underserved population. As noted earlier, few RDNs
participate in the Medicare Physician Quality Reporting System program which becomes problematic in
2015 when Medicare fee for service providers will have their payments reduced if they do not meet
satisfactory reporting requirements90.
Evidence-based Medicine and Practice
Evidence-based medicine (EBM) is defined as “… the conscientious, explicit and judicious use of current
best substantiated data in making decisions about the health care of individual patients91”. The term is
now expanded to “evidence-based practice” (EBP) to include all health professional disciplines. EBP is the
integration of best research with clinical expertise, patient values and available resources92. EBP, a decision
making process, involves the selection and use of the current best available research evidence, clinical
circumstances and the consideration of patient values93. Irrespective of the health field, it is common to
see gaps between research and clinical practice and EBP is used to bridge the gap94.
A total of 342 U.S. credentialed RDNs in clinical practice completed an online survey in a 2011 pilot study
evaluating their perceptions, attitudes, knowledge, clinical practice and clinical use of EBP95. EBP is a
requirement for entry level dietetics education however, the study RDNs responded to using evidencebased resources occasionally even though they had adequate access to the resources. Prior surveys have
reported lack of time as a barrier to the use of EBP. RDNs perception and attitude scores were more
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positive than knowledge scores. Awareness of databases, knowledge of EBP terms, formal training and
access to research mentors were reported to be lacking. Additionally, evidence-based practice training of
health students appears in the literature for medicine and most health programs but little information is
available for nutrition and dietetics curricula94.
EBP is and will continue to be essential to demonstrate cost savings, effectiveness of outcomes and
ultimately justify the impact of the RDN. In 2014, the Institute of Medicine held a roundtable on value and
science-driven health care with the vision for the development of a continuously learning health system in
which science, informatics, incentives and culture are aligned for continuous improvement and
innovation96. The goal is by the year 2020, 90 percent of clinical decisions will be supported by accurate,
timely and up-to-date clinical information and will reflect the best available evidence.
Research
The dietetics profession relies on research to advance practice. In 2006, a cross-sectional, descriptive study
surveyed 258 randomly selected RDNs from Clinical Nutrition Management, Diabetes in Care and
Education, Dietitians in General Clinical Practice, Dietitians in Nutrition Support, Nutrition Educators of
Health Professionals, Renal Dietitians and Research dietetics practice groups were surveyed97. Key
variables reported to predict the level of research skills included perceptions, attitudes, knowledge of
evidence-based practice score, level of education, having taken a research course and how recent research
was read97. Some of the research scores of individual faculty members were comparable to the clinical
RDNs97. This finding may be related to the lower number of food and nutrition research mentors available.
The results from this study imply that current entry level RDNs may have lower research scores.
In 2011, Readex Research, Inc. conducted a survey on Member Research Activities, Needs and Perceptions98
for the American Dietetic Association on the gaps in dietetics-related research. The most common gap
noted by the respondents was limited undergraduate education related to the research process and the
paucity of research examining the cost effectiveness of nutrition intervention and outcomes. RDNs were
strongly interested in public health research on methods to promote behavior change and maintenance,
long-term and sustained community-based health promotion and disease prevention and research on
specific populations such as Hispanics and the elderly. The most commonly cited barriers to RDN research
were lack of research skills, lack of time and/or lack of staff and funding99, 100. Determinants to RDN
involvement in research have been associated with education and knowledge100. The perpetuation and
advancement of the nutrition and dietetics profession depends on evidence-based practice and research
furnishes the basis for the development of the data.
All RDNs will be expected to conduct nutrition research or collaborate in nutrition research as part of their
work activity to establish nutrition outcomes recommendations for individuals and populations. Evidencebased practice is an important tool that includes complicated and cognizant decision making based on the
highest quality of research available and substantiation on patient or client or program or system
characteristics, conditions and subjectivities. Sixteen years ago an article appeared in the Journal of the
American Dietetic Association titled, A Model for Making Outcomes Research Standard Practice in Clinical
Dietetics101. Stakeholders and employers need to value and assign RDNs’ time for research. One model
presented included clinical RDNs collaborating with academic RDNs since the responsibility of academic
dietetics training programs in the integration of research and clinical practice. When academic RDNs are
not as skilled in research, collaboration with allied health faculty colleagues or industry RDNs may help
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supplement training programs. Research skills will be vital to the excellence and advancement of the
profession.
Nutritional Pharmacology
Earlier nutrition and medication communications and the study of medical nutrition therapy focused
primarily on drug-nutrient interaction. However, parallel to advances seen in medical nutrition therapy
and technology, nutritional pharmacology has evolved into a multitude of relationships between nutrition
and medication and the effect of nutritional status on drug metabolism, distribution and effectiveness102,
103
. Polypharmacy increasingly complicates pharmacology. Pharmacology encompasses
pharmacodynamics, pharmacokinetics and phase 1 and 2 of drug metabolism (oxidation reduction
reactions and water-soluble formation, respectively). More information has been learned about the impact
of individual micronutrients on drug pharmacokinetics and pharmacodynamics.
Pharmacokinetics refers to the study of the time course of drug absorption, distribution, metabolism and
excretion (known as ADME). Due to the advances seen in these two clinical areas, RDN education requires
an expanded curriculum to include nutritional pharmacotherapy.
Knowledge and research on phytochemicals has progressed. For example, Chemopreventive and
angiopreventive properties in epigallocatechin (green tea), triterpenoids (citrus juices), resveratrol (red
wine), xanthohumol (beer), procyanidin (chocolate) and caffeine (coffee) have been associated with risk
reduction of cardiovascular diseases, type 2 diabetes, neurodegenerative diseases and some cancers104.
Therefore, nutrition and dietetics practitioners will need to stay at the forefront of on ongoing research
results to translate into practice.
Health Care Practice Setting
There is a shift in health care occurring from new health care legislation (HR 3590) where the emphasis in
acute nutrition care is now moving towards community and public health nutrition evaluation and
intervention. This is predicted to significantly elevate health promotion and disease prevention practice.
The Center for Health Workforce Studies (CWS), with the IOM, conducted an allied health workshop in
2011 on Scope of Practice (SOP) and the Future of Team Based Care15. These thought leaders defined
scope of practice as governance “based in state licensing laws and rules which sets legal framework for
service delivery by a specific health profession in a state, defines parameters of practice for a profession,
limits practice to people who successfully complete specified education and/or training, restricts use of
title and/or credential to license holders in the profession and is designed to provide consumer
protection”14, 15.
This shift will include an increasing use of teams in health care delivery, patient-centered medical homes
and will use interprofessional teams in the provision of health care services. Evolving practice settings,
besides the patient-centered medical home, include accountable care organizations, health homes for
chronically ill, primary care case management and managed care or coordinated care organization
(MCO/CCO). Care will be coordinated among multiple providers and team configurations will vary
depending on patient needs. Team members will actively communicate and collaborate with each in the
delivery of patient care. Robust team cohesiveness will be associated with higher levels of clinical
outcomes. There are emerging models of care that emphasize team based approaches. The success of
these models will require a commitment to team-based education and training and there will be a greater
36
need for regulatory flexibility related to SOP. It will be important to develop impact measures of SOP
changes on efficiency, cost quality and access15.
Increased Medical Complexity and Acuity
Considering the aging population, home-based and hospital patients with multiple chronic diseases will
increase. RDNs will need to be proficient in determining and prioritizing nutritional care while
understanding the significance of multiple diseases and their conflicting pathology105. As a part of
designing nutritional care, RDNs will be writing diet orders and other increasing scope of practice functions
which will impact outcomes, safety, timeliness of care and readmission rates. Therefore, important areas
of RDN’s knowledge include acid-base balance and compensatory mechanisms, electrolyte abnormalities,
fluid shifts and edema, acute changes in liver, renal, cardiac, respiratory function, multi-system organ
failure and nutritional pharmacology to name a few106. Concurrently, RDNs will continue to be faced with
demonstrating the benefits of treatment by the RDN for patients with multiple medical conditions107.
Public Health
The health care shifts from acute care to chronic disease care and prevention public health will greatly
change public health nutrition. On one end of the spectrum, public health will become more integrated
with nutrition and on the other end there will be an increased demand for RDNs to have enhanced clinical
nutrition skills due to the increasing severity of illness in the community108. The National Prevention,
Health Promotion and Public Health Council from the Office of the Surgeon General advocates for a
National Prevention Strategy: America’s Plan for Better Health and Wellness19, 43. Two of the seven
priorities require nutrition expertise (Healthy Eating and Active Living). The upcoming 2015 Dietary
Guidelines for America (DGA) will include nutrition and lifestyle recommendations and anticipatory
guidance for pregnant and lactating women, as well as, infants and toddlers, which are new additions to
the DGA. The new additions result from the solid evidence of epigenetic effects of nutrition imprinting and
from the multitude of studies demonstrating rapid infant weight gain in the first three months of life on
later development of obesity.
Branding and Marketing
RDNs, in general, do not market themselves or communicate their roles as food and nutrition experts to
non-dietetics groups109. The vast public interest in nutrition continues to grow and there is often confusing,
and sometimes conflicting, research reports and advice in the popular media. Therefore, RDNs,
individually and as an organization, will need to promote the RDN brand. Besides confusion around
nutrition in the popular media, there is public uncertainty around identifying qualified nutrition
professionals. RDN’s active participation in the profession’s and its practitioners’ ‘branding’ process will be
instrumental in demonstrating RDN’s superior nutritional expertise compared to competitors.
In 2011, on behalf of the Academy, Polaris Marketing Research conducted a qualitative survey followed by
a quantitative evaluation of the RDN brand110. The purpose of the survey was to understand perceptions of
the RDN in the marketplace. The survey population consisted of member and non-member RDNs,
physicians, nurses and consumers (n=1,558). The results indicated a strong RDN brand with the exception
of low awareness of RDNs among consumers. There was a segment of consumers that believed that RDNs
prescribe an inflexible diet without considering the consumer’s preferences or lifestyle. As the public
becomes increasingly interested in nutrition, competition from other nutrition and health professionals is
also increasing. The RDN brand must become stronger with distinct and pervasive messaging in the
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marketplace to differentiate RDNs from other nutrition and health professionals. This will be accomplished
by implementing RDN communication and services aimed at focused consumer groups.
Industry Knowledge and Skills
RDNs working in business and industry are trained and exposed to new and different knowledge and skills,
not otherwise included in the nutrition and dietetics curriculum. Some examples include, but are not
limited to, product development, which requires knowledge and expertise in good manufacturing practice,
industrial food production, sensory testing, writing specifications, disassembling, primary and secondary
processing. RDNs who work in regulatory affairs are individuals who ensure regulatory compliance and
prepare submissions, as well as those whose main job function is clinical affairs or quality assurance and
are all considered regulatory professionals. Regulatory professionals can be employed in industry,
government and academia and are involved with a wide range of products, including: pharmaceuticals,
medical devices, in vitro diagnostics, biologics and biotechnology, nutritional products, cosmetics and
veterinary products.
Regulatory professionals come from diverse backgrounds. Most regulatory professionals have earned a
bachelor's degree and more than half have an advanced degree, most often in a scientific or technical field.
Valuable skills include project management and organization, negotiation and communication and the
ability to learn from the experience of others, both inside and outside the organization.
Nutrition-industry prospective clinical trials (NICTs) are often developed to show either safety/tolerance or
efficacy, or both in many cases for a new nutrition product111. NICTs may also be initiated to support a
marketing claim based on either a novel ingredient (e.g. docosahexaenoic acid-DHA) or new application
(e.g. liquid versus powder). Types of NICTs include drugs (investigational new drug - IND), infant formula,
medical food, biologics and medical devices. RDNs are part of the ‘pipeline’ where they organize and run
focus groups and advisory boards with key opinion leaders to generate product ideas and develop multicenter research protocols. NICTs are run to the same standards as pharmaceutical drug trials and infant
formula results must be approved by the FDA. Industry RDNs are trained in a multitude of valuable skills
such as project management, leadership, study monitoring and product production, packaging, labeling
and distribution, adverse event reporting and coding, post-market product surveillance and monitoring,
medical writing and statistics.
SUMMARY
The environmental scan represents an extensive examination and comparison of the current and future
states of the rapidly growing and increasingly complex health care system. It examines stakeholder needs,
findings in global and national reports, advances in medical science and technology, preparation and roles
of other health professionals and the professional preparation of nutrition and dietetics practitioners. As
noted by IOM and the Lancet Commission, the global health care systems are fractured and health
professional education is old and disconnected. Five competencies recommended by the IOM for all health
professionals include: patient-centered care, interdisciplinary teams and research, evidence-based
practice, continuous quality improvement and informatics. There areas further demonstrate opportunities
to gentrify the educational preparation of nutrition and dietetics professionals to meet today’s and
tomorrow’s health care system demands.
Educational levels and changes observed in other health professions provides timely guidance for RDN
38
educational programs. Namely, the majority of health professions have established multiple degree levels.
A graduate degree, often doctoral degree, represents the entry level professional practice degree for most
of the health professions. All of the health professions require a significant number of hours in supervised
practice (or its equivalent) as part of their overall training and education. Therefore, the success and
advancement of the nutrition and dietetics practitioner may require a progressed academic preparation
that includes interdisciplinary education, informatics, telehealth, skills thinking, nutritional genomics,
nutritional pharmacology, case management, coding and reimbursement, evidence-based practice and
outcomes research, behavioral counseling and multi-disease clinical care to meet the growing demands of
advancing knowledge, skills and new practice settings.
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STAKEHOLDER INPUT
Stakeholder Interviews and Analysis Stakeholder Survey Data
Collection and Analysis Employer Survey Data Collection and
Analysis Competency Gap Analysis
Stakeholder Input on Future Model Recommendations
STAKEHOLDER INTERVIEWS AND ANALYSIS
PURPOSE
The purpose of this project was to gather information from various stakeholders to determine the
additional knowledge and skills needed at various levels of employment for future practitioners.
METHODOLOGY
ACEND® contracted with Dr. Barry Dornfeld and the Center for Applied Research (CFAR) Consulting Group
to conduct structured interviews with representative stakeholders to help inform the development of a
questionnaire to gather information from stakeholders about skills needed in future practice in nutrition
and dietetics. A total of 10 interviews were conducted with stakeholders representing healthcare
administration (pharmacy, nursing), deans of allied health colleges, employers of less traditional roles
(communications, marketing and management), physicians, educators in allied health graduate programs
and researchers.
RESULTS
Several themes emerged from the interviews:

Communication skills are an essential and under-developed focus in dietetics training at the
entry level.

It is critical for dietitians to understand the health of the patient in context with the patient’s
community and cultural ecosystem.

Entry level dietitians will be expected to participate in interprofessional and interdisciplinary
teams. Training programs need to incorporate teams as a critical component of education.

Healthcare practitioners expect bachelor’s-trained dietitians to be able to provide health and
wellness counseling.

The ability to read, interpret and apply scientific knowledge is an increasingly essential
component of nutrition and dietetics practice at the bachelor’s level, but many are not
adequately prepared.

Clinical experience is highly valued by employers. However, patient-assessment skills are lacking
at all levels of nutrition and dietetics practice.

Supervised practice experience is of high value. But the accessibility and quality of experiences is
inconsistent, frustrating employers of nutrition and dietetics practitioners.

Credible advanced practice credentials remain important in raising the competency level of
dietitians and to address the increasing rate of chronic and complex diseases.

A master’s degree is viewed as the ideal, at a minimum, by many private sector and healthcare
employers, but expectations vary widely based on degree level

Employers expect strong organizational leadership and project management skills especially at
higher education levels, however, the expectations vary.
 Nutrition and dietetics is becoming increasingly globalized.
41
STAKEHOLDER SURVEY DATA COLLECTION AND ANALYSIS
PURPOSE
The purpose of this project was to gather information from various stakeholders on the importance of
specific skills for future practice in nutrition and dietetics.
METHODOLOGY
Using data gathered from the environmental scan and structured interviews with stakeholders, ACEND®
worked with Dr. Barry Dornfeld and the CFAR Consulting Group to develop an online questionnaire in
Survey Monkey® that included two major sections: one for collecting demographic information about
respondents and the other for collecting respondent ratings on the importance of 79 skills for future
practice in nutrition and dietetics (see Appendix A). The skills were organized into six skill sets: professional
research and practice skills (7 items), teamwork and communication skills (7 items), clinical client care skills
(26 items), community and population health skills (11 items), leadership, management and organization
skills (18 items) and food and foodservice systems (10 items). These skill set categories were developed
based on input collected in the stakeholder interviews. CFAR and the Expanded Standards group identified
specific skills within each category. Respondents were asked to rate the importance of each skill for future
practice in nutrition and dietetics using a four-point scale ranging from 1, not important to 4, very
important. An option of “unable to answer” also was included. Respondents were given the opportunity in
open-ended questions to describe any additional skills that might be needed by nutrition and dietetics
professionals in the future.
A cover letter with a link to the questionnaire was emailed to all of the individuals in the Academy of
Nutrition and Dietetics database. A follow-up reminder email was sent two weeks later. Individuals were
asked to complete the survey themselves and to forward the request to employers of nutrition and
dietetics practitioners and professionals who worked with nutrition and dietetics professionals. Emails
were also sent to Academy of Nutrition and Dietetics and dietetic practice group leadership asking their
assistance in encouraging response.
ACEND worked with Dr. J.T. Johnson, a statistician and director of the Center for Research at the University
of Southern Mississippi, to analyze and interpret data. Descriptive statistics were run for all variables and
inferential statistics were used to compare ratings by demographic variables.
RESULTS
Because of the snowball distribution process, the number of possible respondents is not known. A total of
9,477 stakeholders participated in the survey.
Demographic Information
As presented in Table 2, the most common practice setting noted by participants was healthcare (52.7%)
followed by education (17.5%). The setting with the smallest number of participants was communications
and media (1.2%). Direct patient care was the most frequently mentioned role (55.3%) followed by
education (24.4%). Students or interns comprised 10.1% of the participants. Education level of participants
was fairly evenly split between a bachelor’s (43.7%) and master’s (45.2%) degree. Most (94.9%) of the
respondents held the RDN credential; 3.8% held the DTR credential. Most (72.2%) responded to the
questionnaire from the perspective of the RDN; the remaining responses were split from the perspective of
42
students/interns (8.8%), educators (5.5%), professionals who work with RDNs/DTRs (3.6%) and employers
who hire RDNs/DTRs (3.4%). More than one-third of the participants
(36.6%) had > 20 years of experience, followed by those with 10-20 years (20.0%). All regions of the
country were represented and responses were received from all states.
Importance of Future Skills
Respondents rated all of the future skills on a four-point scale with 4 being very important. Most (89%) of
the individual skills had mean ratings greater than three suggesting that skills were important for future
practice; 40% were rated greater than 3.5 suggesting they were very important (see Table 3).
The importance ratings for individual skills within a skill category were averaged to give an overall mean
score for each skill set category (see Table 4). All of the skill set categories had strong coefficient alpha
reliability indicators (alpha .80 or higher) suggesting good internal consistency among the skills included in
that category. Results suggested that all six skill set categories (professional research and practice skills;
teamwork and communication skills; clinical client care skills; community and population health skills;
leadership, management and organization skills; and food and foodservice systems) were important for
future practice with teamwork and communication skills receiving the highest mean score (M=3.64) and
leadership, management and organizational skills the lowest mean score (M=3.15).
Analysis of Variance was used to explore differences in skill set scores based on demographic variables of
the respondents. Statistical differences (p<.05) were found among the skill set mean scores based on
respondent setting, level of education, years of experience and perspective from which they answered the
questionnaire; however, the practical significance of the differences may be of less importance as all mean
ratings differed by less than .3 on a 4 point scale (see Table 5).
Differences Based on Setting:
 Professional Research and Practice: Those in the healthcare setting had a lower mean importance
score for the professional research and practice skill set than those in education (P<.001) and
corporate (P<.001) settings and those with no work experience (P=.002). Those in education had a
higher mean importance score than those in government (P=.007), wellness (P=.018) and
community settings. Those in wellness and government settings and those who were self-employed
all had higher mean importance scores in the professional research and practice skill set than those
in the corporate setting (P=.007, .002, .002 and .013, respectively).
 Teamwork and Communication: There was no difference found in the mean importance scores
based on setting for the teamwork and communication skill set.
 Clinical Client Care: Those in the healthcare setting had a higher mean importance score for the
clinical client care skill set than those in community (P=.034) and government (P=.002) settings and
those with no work experience (P=.025). Those with no work experience had a higher mean
importance score than those in education (P<.001), community (P<.001), corporate (P=.004) and
government (P<.001) settings. Those that were self-employed had a lower mean importance score
for the clinical client care skill set than those in the community (P=.017) and government (P=.008)
settings.
43
Differences Based on Setting (cont.):
 Community and Population Health: Those in the healthcare setting had a lower mean importance
score for the community and population health skill set than several other settings, including
education (P<.001), community (P<.001), government (P<.001), and wellness (P=.006) settings and
those with no work experience (P<.001). Those that were self-employed had a lower mean
importance score for the community and population health skill set than those in the government
(P=.032) and community (P=.028) settings.
 Leadership, Management and Organizational: Those in the healthcare setting had a lower mean
importance score for the leadership, management and organizational skill set than those in
education (P=.001) and government (P=.043) settings.
 Food and Food Systems: Those in the healthcare setting had a lower mean importance score for the
food and food systems skill set than those in the education (P<.001) setting and those with no work
experience (P<.001).
Differences Based on Highest Level of Education:
 Professional Research and Practice: Those with at high school degree as their highest level of
education (assumed to be students) had a higher mean importance score for the professional
research and practice skill set than did those with an associate’s degree (P=.009), bachelor’s degree
(P<.001) and master’s degree (P=.028). Those with a master’s degree or doctorate, had a mean
importance score that was significantly higher than those with a bachelor’s degree (P<.001 for
both).
 Teamwork and Communication: Those with a master’s degree had a higher mean importance score
for the teamwork and communication skill set than did those with a bachelor’s degree (P=.002).
 Clinical Client Care: Those with a high school degree had a higher mean importance score for the
clinical client care skill set than those with an associate’s degree (P=.057), bachelor’s degree
(P<.001), master’s degree (P<.001) or a doctorate (P<.001).
 Community and Population Health: High School graduates had a higher mean importance score for
the community and population health skill set than those with an associate’s degree (P=.044) but a
lower score than those with a bachelor’s degree (P=.001). Those with bachelor’s degree had a
lower mean importance score for the community and population health skill set than did those
with a master’s degree (P<.001) or a doctorate (P=.001).
 Leadership, Management and Organizational: There were no differences found in the mean score
for the leadership, management and organizational skill set based on highest level of education.
 Food and Food Systems: High school graduates had a higher mean importance score for the food
and foodservice systems skill set than those with a bachelor’s degree (P=.001), master’s degree
(P=.001) or a doctorate (P=.001).
44
Differences Based on Credential:
 No significant differences were found in the mean scores for any of the skill set scores based on the
respondent’s credentials.
Differences Based on Years of Work Experience:
 Professional Research and Practice: Respondents with no work experience (assumed to be students
and interns) had a higher mean importance score for the professional research and practice skill set
than all other years of work experience groups, including < 3 years (P<.001), 4-10 years (P<.001), 1020 years (P<.001) and > 20 years (P<.001).





Teamwork and Communication: There was no difference found in the mean scores for the
teamwork and communication skill set based on years of work experience.
Clinical Client Care: Respondents with no work experience had a higher mean importance score for
the clinical client care skill set than did all other work experience groups, including < 3 years
(P<.001), 4-10 years (P<.001), 10-20 years (P<.001) and > 20 years (P<.001). Those with < 3 years of
work experience had a higher mean importance score than those with 10-20 years of work
experience (P=.015) and those with > 20 years of experience (P<.001). Those with 4-9 years of
experience had a higher mean importance score than those with > 20 years of work experience
(P=.001).
Community and Population Health: Those with no work experience had a higher mean importance
score for the community and population health skill set than all other work experience groups,
including < 3 years (P<.001), 4-10 years (P<.001), 10-20 years (P<.001) and > 20 years (P<.001).
Those with < 3 years of experience also had a higher mean importance score than those with 10-20
years (P<.001) and > 20 years (P<.001) of work experience. Respondents with 4-9 years of work
experience had a higher mean importance score than those with >20 years of experience (P=.008).
Leadership, Management and Organizational: Those with > 20 years of work experience had a
lower importance score for the leadership, management, and organizational skill set than did those
with < 3 years of experience (P<.001), 4-9 years of experience (P<.001) and 10-20 years of work
experience (P<.001).
Food and Food Systems: Those with no experience had a higher mean importance score in the food
and foodservice systems skill set than did those with < 3 years (P=.003), 4-10 years (P<.001), 10-20
years (P<.001) and > 20 years (P=.001) of work experience. Those with 10-20 years of work
experience had a lower mean importance score than those with <3 years (P=.030) and with > 20
years (P=.011) of work experience.
Differences Based on Perspective for Answering the Questionnaire:
 Professional Research and Practice: Those who reported their perspective as DTRs had a lower
mean importance score for the professional research and practice skill set as compared to those
reporting their perspective as employer (P=.024), professionals who work with RDNs and DTRs
(P<.001), educators (P=.002), students (P<.001) and interns (P<.001). The mean importance score of
RDNs was lower than scores for professionals who work with RDNs and DTRs (P=.010), students
(P<.001) and interns (P<.001).
45
Differences Based on Perspective for Answering the Questionnaire (cont.):
 Teamwork and Communication: There were no difference found in the mean importance scores
for the teamwork and communication skill set based on perspective for answering the
questionnaire.
 Clinical Client Care: Those reporting their perspective as student had a higher mean importance
score for the clinical client care skill set than those reporting their perspective as RDNs (P<.001),
DTRs (P<.001), employers (P<.001), professionals who work with RDNs and DTRs (P<.001) and
educators (P<.001). Similarly, those reporting their perspective as interns also had a higher mean
importance score than those reporting as RDNs (P<.001), DTRs (P<.001), employers (P<.001),
professionals who work with RDNs and DTRs (P<.001) and educators (P=.002).
 Community and Population Health: Those reporting their perspective as educators had a higher
mean importance score for the community and population health skill set than those reporting as
RDNs (P<.001), DTRs (P=.006), employers (P<.001) and professionals who work with RDNs and DTRs
(P=.013). Those reporting as students or interns had higher mean importance scores than RDNs
(P<.001), DTRs (P<.001), employers (P<.001) and professionals who work with RDNs and DTRs
(P<.001).
 Leadership, Management and Organizational: Those reporting their perspective as employers had
a higher mean importance score for the leadership, management and organizational skill set than
those reporting as RDNs (P<.001) and professionals who work with RDNs and DTRs (P<.001). Those
reporting their perspective as educators had higher mean importance scores than RDNs (=.033) and
professionals who work with RDNs and DTRs (P=.031).
 Food and Food Systems: Those reporting their perspective as students had a higher mean
importance score for the food and food systems skill set than those reporting as RDNs (P<.001),
employers (P<.001) and professionals who work with RDNs and DTRs (P=.002). Those reporting
their perspective as Interns also had a higher mean importance score than those reporting as RDNs
(P<.001) and professionals who work with RDNs and DTRs (P=.020).
46
Table 2: Demographic characteristics of stakeholders
Characteristics
%a
n
Work Setting
Healthcare (hospital, long term care, physician network)
4698
52.7%
Educational setting (primary, secondary, university)
1558
17.5%
Government (federal, city, state, or local) public health
1126
12.6%
Self-employed consultation or private practice
867
9.7%
Community nonprofit
724
8.1%
Wellness programs (workplace, health club, fitness centers)
622
7.0%
Corporate/industry settings (R&D, marketing, sales, etc.)
365
4.1%
Behavioral care clinics (rehabilitation, mental illness, etc.)
308
3.5%
Communications and media
110
1.2%
Not currently working
761
8.5%
Direct patient care (physician, nurse, pharmacy, dietitian)
4929
55.3%
Education
2178
24.4%
Administration/management
1721
19.3%
Community/population health
1557
17.5%
Foodservice
1111
12.5%
Student/intern
904
10.1%
Research (basic science and medical)
507
5.7%
Policy expert/advocate
262
2.9%
Research (product R&D)
89
1.0%
High School
203
2.2%
Associate
264
2.8%
Bachelor’s
4107
43.7%
Master’s
4244
45.2%
Doctorate
605
6.4%
7928
94.9%
DTR or NDTR
317
3.8%
RN
118
1.4%
MD
28
0.3%
PharmD
11
0.1%
Role
Highest Degree Held
Credentials Held
RD or RDN
a
In some cases, total n is greater than total number of responses and percentages total more than 100%
as respondents were allowed to ‘select all that apply’
47
Table 2: cont.
Characteristics
n
%a
Perspective Responding to the Questionnaire
As a registered dietitian
6844
72.2%
As a dietetic technician, registered
283
3.0%
As an employer who hires registered dietitians or dietetic technicians
321
3.4%
As a professional who works with registered dietitians or dietetic technicians
342
3.6%
As a dietetics educator
519
5.5%
As a dietetics student
496
5.2%
As a dietetic intern
339
3.6%
No experience
574
6.1%
3 years or less
1781
18.8%
4 to 9 years
1674
17.7%
10 to 20 years
1899
20.0%
More than 20 years
3472
36.6%
Region 1 (AK, CA, HI, ID, MT, OR, WA, WY)
1427
15.6%
Region 2 (IA, MI, MN, MO, NE, ND, SD, WI)
1372
15.0%
Region 3 (AL, AR, FL, GA, LA, MS, PR, SC)
1247
13.6%
Region 4 (AZ, CO, KS, NM, NV, OK, TX, UT)
1269
13.9%
Region 5 (IL, IN, KY, OH, TN, WV)
1481
16.1%
Region 6 (DE, DC, MD, NC, PA, VA)
1084
11.8%
Region 7 (CT, ME, MA, NH, NJ, NY, RI, VT)
1279
14.0%
Years of Work Experience
Region of the Country
48
Table 3. Stakeholder ratings of importance of skills for future practice in nutrition and dietetics
Skill
n
Mean a
Std. Dev
Professional Research and Practice Skills

Collect and interpret data for use in decision making and evaluation
8009
3.57
.654

Engage in quality assurance and performance
improvement activities
8009
3.48
.679

Analyze, evaluate and critique scientific studies
8009
3.48
.717

Use data collected to make operational decisions
8009
3.47
.704

Lead efforts in health, food and nutrition policy development,
implementation and evaluation
8009
3.44
.748

Perform data analysis
8009
3.21
.811

Design, conduct, analyze and disseminate basic science,
clinical and/or translational research
8009
3.14
.847
Teamwork and Communication Skills

Accurately communicate evidence-based information
8313
3.86
.387

Translate dietetics vocabulary across disciplines and in laymen
terms
8313
3.76
.508

Participate in team decision making
8313
3.75
.492

Use cross cultural skills effectively in communication
8313
3.66
.550

Develops and uses a variety of media and technologies to
communicate messages and education
8313
3.54
.639

Lead transdiscplinary, interprofessional and/or interdisciplinary
teams
8313
3.50
.661

Employ strategies and facilitate team building
8313
3.43
.682
Assess nutrition status in clients with a variety of diseases and medical
conditions
6267
3.86
.414
Develop, monitor and evaluate nutrition interventions in clients with
a variety of diseases and medical conditions
6267
3.85
.422

Diagnose nutrition problems in clients with a variety of diseases and
medical conditions
6267
3.81
.479

Counsel clients with multiple diseases/medical conditions and those
who require complex nutrition care using appropriate behavior
change theories and techniques
6267
3.78
.505

Interview clients for nutrition risk and diet history
6267
3.76
.517

Prescribe and manage therapeutic diets (renal, cardiac, diabetes,
phenylketonuria)
6267
3.75
.562
Clinical Client Care Skills


a
scale: 1, not important to 4, very important for future practice in nutrition and dietetics
49
Table 3. (cont.)
Skill
n
Mean a
Std. Dev
Clinical Client Care Skills (cont.)

Analyze food intake in clients with a variety of diseases and medical
conditions
6267
3.73
.534

Educate clients in health maintenance and disease prevention
6267
3.73
.522

Prescribe and manage enteral and parenteral nutrition
6267
3.69
.646

Provide nutrition care for clients who have multiple diseases/medical
conditions and complex nutrition and health needs (e.g. palliative
and hospice care, oncology, high risk pregnancy)
6267
3.69
.594

identify sociological, psychological and environmental influences on
eating behavior
6267
3.64
.576

Implement designated dietary interventions based on protocol
6267
3.60
.625

Counsel clients affected with disorders that are serious in nature,
including eating disorders
6267
3.60
.641
Write nutrition orders for nutrition supplements, vitamins
and minerals
6267
3.57
.723

Apply integrative nutrition principles to nutrition care and Medical
Nutrition Therapy (MNT), including the use of nutritional genomics,
dietary supplements and/or herbal remedies
6267
3.56
.665

Assess individual’s physical, social and cultural needs
6267
3.53
.683

Counsel clients on appropriate ways and methods to increase physical
activity
6267
3.48
.688

Order nutrition related laboratory tests
6267
3.45
.743

Perform calculations for risk assessment following protocol
6267
3.43
.733

Conduct nutrition focused physical exams as part of assessment
6267
3.34
.797

Manage nutrition related medication of clients
6267
3.34
.778

Lead client care coordination/case management
6267
3.19
.838

Perform routine tests (e.g. finger stick for blood glucose, urine
analysis) to assess and monitor clients’ nutrition and health status
6267
2.79
1.008

Prescribe or dispense adjustment of insulin and oral hypoglycemic
regimens
6267
2.87
1.005
Conduct psychotherapy, including cognitive behavioral therapy and
solutions focused therapy
6267
2.80
1.020
Insert nasal gastric feeding tubes
6267
2.25
1.048



50
Table 3. (cont.)
Skill
n
Mean a
Std. Dev
Food and Foodservice Systems Skills

Develop menus and standardized recipes for diverse groups for
normal and therapeutic diets applying principles of menu planning
and knowledge of medical nutrition therapy and therapeutic
nutrition
6650
3.56
.673

Complete nutrient analysis of food products, recipes and menus
6650
3.51
.701

Teach others how to prepare healthy foods using knowledge of food
science and culinary techniques
6650
3.48
.718

Plan and implement food safety and sanitation programs
6650
3.37
.804

Manage production and service of food that meets nutrition
guidelines, cost parameters and health needs
6650
3.36
.795
Conduct operational analyses and streamline operations to reduce
costs while ensuring health related goals are not compromised
6650
3.31
.792

Manage food distribution and service ensuring accuracy, quality and
portion control
6650
3.25
.838

Evaluate purchasing needs and develop specifications for food and
equipment
6650
3.14
.858

Negotiate purchases and contracts for products and services
6650
2.97
.914

Design foodservice systems (layout, equipment)
6650
2.90
.932

Community and Population Health

Serve as a nutrition resource for community organizations
7033
3.65
.600

Provide nutrition and life style education to well populations
7033
3.55
.660

Design and implement culturally appropriate nutritional initiatives
and programs
7033
3.41
.726

Interpret and use national nutrition surveillance data and population
based statistical data
7033
3.33
.742

Interpret basic population based statistical data
7033
3.31
.738

Assess the need to develop and implement a community or
population health program and/or intervention considering
biological, behavioral, psychological, social, economic, policy and/or
environmental factors
7033
3.29
.752

Convene and mobilize community partnerships and coalitions to
identify and solve food, nutrition and/or health related issues by
building on community assets and focusing on policy, systems and
environmental strategies
7033
3.27
.781
Develop and utilize nutrition and health surveillance systems to monitor
and identify population and community health and nutrition priorities
and problems; communicate results to local, state and national health
authorities and policy makers
7033
3.25
.781

51
Table 3. (cont.)
Skill
n
Mean a
Std. Dev
Community and Population Health (cont.)

Conduct culinary demonstrations to teach cooking skills, safe food
handling practices and promote consumption of healthy foods
7033
3.25
.805

Develop and evaluate policies, laws and regulations that address and
protect health and nutrition for individuals and populations
7033
3.24
.769
Identify and seek funding sources for development and ongoing
maintenance of community health programs
7033
3.15
.822
Lead process improvement activities to improve delivery of food and
nutrition services
6261
3.38
.742

Advocate for changes in policies to improve access to food and
nutrition services for the public
6261
3.35
.780

Lead initiatives to improve use of sustainable practices in food and
nutrition services
6261
3.29
.796

Demonstrate conflict resolution and mediation skills
6261
3.27
.804

Develop operational policies, procedures, job descriptions, work
schedules and performance standards
6261
3.22
.811

Manage staffing functions such as interviewing, hiring, motivating,
supervising, evaluating and terminating employees
6261
3.20
.840

Conduct employee performance evaluations and counsel employees
for performance improvement
6261
3.18
.841

Conduct employee orientation and training programs
6261
3.16
.835

Identify opportunities for increasing revenue
6261
3.16
.855

Adjust operations based on financial performance
6261
3.10
.871

Direct strategic planning
6261
3.03
.886

Develop, implement and evaluate marketing plans for new products,
programs and services
6261
3.03
.861

Develop operational and capital budgets
6261
3.02
.904

Develop emergency preparedness plans for facilities, patients/clients
and/or communities
6261
3.01
.905

Develop business plans to sell ideas and turn ideas into action
6261
2.99
.882

Evaluate and make recommendations for equipment, layout and
design or redesign of facilities
6261
2.98
.897

Develop informatics systems in collaboration with programmers
6261
2.87
.890

Leadership, Management and Organizational Skills

52
Table 4. Skill set importance scores and score reliability
n
Mean a
Std. Dev
Cronbach’s
Alpha
Teamwork and Communication Skills
8563
3.64
.384
.798
Clinical Client Care Skills
8014
3.46
.429
.933
Professional Research and Practice Skills
8726
3.40
.510
.819
Community and Population Health Skills
7615
3.33
.574
.929
Food and Foodservice Systems Skills
7105
3.28
.658
.945
Leadership, Management and Organizational Skills
7302
3.15
.649
.962
Skill Set
a
scale: 1, not important to 4, very important for future practice in nutrition and dietetics
53
Table 5. Comparison of mean importance scores based on demographic data
Characteristic
Research
n
Mb ± SD
Client Care
n
Mb ± SD
Skill Set
Community
Teamwork
b
n
M ± SD
n
Mb ± SD
Leadership
n
Mb ± SD
Foodservice
n
Mb ± SD
Setting c
Healthcare
Behavioral care
Education
Community
Government
Wellness
Corporate
Communications
Self Employed
Not Working
3338
56
928
338
693
184
210
24
316
615
3.36 ± .519
3.32 ± .550
3.46 ± .459
3.36 ± .526
3.37 ± .538
3.32 ± .591
3.53 ± .405
3.54 ± .378
3.37 ± .552
3.45 ± .474
3126
53
827
303
635
156
183
20
284
542
3.47 ± .384
3.55 ± .374
3.43 ± .468
3.38 ± .556
3.39 ± .499
3.45 ± .448
3.39 ± .494
3.51 ± .372
3.51 ± .389
3.53 ± .409
2910
50
833
296
621
144
181
21
269
502
3.22 ± .621
3.26 ± .749
3.40 ± .494
3.48 ± .495
3.46 ± .515
3.41 ± .544
3.33 ± .523
3.52 ± .409
3.32 ± .587
3.40 ± .531
3276
55
911
333
681
174
208
24
305
603
3.64 ± .385
3.66 ± .344
3.64 ± .371
3.66 ± .414
3.64 ± .390
3.59 ± .444
3.64 ± .384
3.71 ± .330
3.63 ± .409
3.61 ± .394
2803
46
808
278
602
128
173
19
257
471
3.09 ± .676
3.10 ± .689
3.20 ± .601
3.14 ± .635
3.18 ± .624
3.13 ± .704
3.21 ± .583
3.20 ± .536
3.13 ± .699
3.17 ± .614
2751
46
799
269
560
120
165
17
244
464
3.21 ± .688
3.36 ± .589
3.38 ± .584
3.29 ± .688
3.30 ± .674
3.28 ± .711
3.26 ± .628
3.35 ± .630
3.24 ± .654
3.36 ± .576
Level of Education c
High School
Associate
Baccalaureate
Master’s
Doctorate
158
232
3742
3947
578
3.54 ± .438
3.37 ± .570
3.35 ± .523
3.42 ± .503
3.48 ± .442
133
213
3430
3629
545
3.63 ± .399
3.51 ± .514
3.46 ± .427
3.46 ± .425
3.43 ± .436
123
195
3226
3482
528
3.49 ± .512
3.31 ± .647
3.29 ± .592
3.36 ± .564
3.38 ± .500
151
228
3673
3869
574
3.65 ± .359
3.60 ± .458
3.63 ± .392
3.66 ± .370
3.61 ± .391
121
186
3080
3342
512
3.19 ± .681
3.16 ± .699
3.10 ± .657
3.19 ± .636
3.13 ± .648
113
185
3006
3243
500
3.53 ± .517
3.39 ± .654
3.28 ± .656
3.28 ± .660
3.25 ± .674
7307
281
73
23
8
3.39 ± .512
3.32 ± .598
3.51 ± .420
3.42 ± .429
3.31 ± .326
6742
253
70
22
8
3.45 ± .421
3.38 ± .598
3.45 ± .392
3.33 ± .526
3.37 ± .324
6422
235
66
19
8
3.32 ± .572
3.26 ± .646
3.39 ± .529
3.39 ± .468
3.13 ± .609
7177
281
107
26
10
3.65 ± .378
3.58 ± .445
3.61 ± .463
3.48 ± .486
3.56 ± .346
6176
222
62
18
8
3.15 ± .644
3.15 ± .705
2.97 ± .731
3.01 ± .658
2.78 ± .627
6004
221
60
17
8
3.27 ± .663
3.38 ± .663
3.31 ± .676
3.25 ± .520
2.81 ± .849
Credential
RD/RDN
DTR/NDTR
RN
MD
PharmD
a Skill
Sets include: professional research and practice skills; clinical client care skills; community and population health skills; teamwork and communication skills; leadership,
management and organization skills; and food and foodservice systems.
b Scale:
c
1, not important to 4, very important for future practice in nutrition and dietetics practice
Differences (p<.05) found among some means; results presented in Rational Document text.
54
Table 5. (cont.)
Characteristic
Research
n
Mb ± SD
Client Care
n
Mb ± SD
Skill Set
Community
Teamwork
b
n
M ± SD
n
Mb ± SD
Leadership
n
Mb ± SD
Foodservice
n
Mb ± SD
Years Work
Experience c
None
3 or less
4-9
10-20
More than 20
483
1618
1531
1768
3268
3.51 ± .429
3.40 ± .504
3.39 ± .516
3.37 ± .529
3.40 ± .510
423
1456
1375
1620
3087
3.64 ± .355
3.49 ± .430
3.48 ± .422
3.45 ± .443
3.43 ± .427
388
1354
1295
1547
2982
5844
238
290
300
461
354
264
3.46 ± .416
3.3801 ± .616
3.3781 ± .462
3.4281 ± .436
3.4721 ± .389
3.65 ± .362
3.6008 ± .365
5541
222
287
289
454
327
247
3.51 ± .464
3.41 ± .555
3.35 ± .581
3.30 ± .593
3.29 ± .575
466
1570
1508
1731
3230
3.67 ± .369
3.64 ± .377
3.62 ± .397
3.62 ± .396
3.66 ± .377
365
1263
1228
1488
2909
6223
258
310
313
484
400
287
3.65 ± .379
3.58 ± .452
3.66 ± .351
3.63 ± .380
3.64 ± .379
3.63 ± .396
3.68 ± .378
6223
258
310
313
484
400
287
3.16 ± .647
3.07 ± .661
3.08 ± .664
3.11 ± .656
3.23 ± .624
355
1245
1194
1426
2838
3.44 ± .534
3.30 ± .657
3.27 ± .656
3.22 ± .683
3.29 ± .656
Perspective
Answering c
RD/RDN
DTR/NDTR
Employer
Other Professional
Educator
Student
Intern
6346
263
313
316
489
419
292
3.38 ± .518
3.29 ± .623
3.43 ± .439
3.48 ± .468
3.45 ± .480
3.51 ± .448
3.50 ± .433
55
3.31 ± .577
3.27 ± .662
3.25 ± .607
3.30 ± .606
3.44 ± .485
3.50 ± .486
3.53 ± .467
3.13 ± .651
3.15 ± .717
3.30 ± .588
3.07 ± .691
3.23 ± .597
3.18 ± .628
3.14 ± .655
5171
212
267
269
434
295
232
3.26 ± .670
3.38 ± .672
3.26 ± .646
3.24 ± .658
3.35 ± .614
3.46 ± .545
3.44 ± .522
EMPLOYER DATA COLLECTION AND ANALYSIS
PURPOSE
The purpose of this project was to gather information from employers on how essential specific skills
were for future employability of nutrition and dietetics practitioners.
METHODOLOGY
Using data gathered in the stakeholder survey and review by an expert panel, ACEND® collaborated
with Dr. Barry Dornfeld and the CFAR Consulting Group to develop an online questionnaire in Survey
Monkey® that included two major sections: one for collecting demographic information about
respondents and the other for collecting respondent ratings of how essential each of 69 skills were for
future employability in nutrition and dietetics practice (Appendix B). The skills were organized into six
skill sets: professional research and practice skills (6 items), teamwork and communication skills (8
items), clinical client care skills (22 items), community and population health skills (9 items),
leadership, management and organization skills (14 items) and food and foodservice systems (10 items)
based on information collected in the stakeholder interviews. Skills rated as important in the
stakeholder survey and those recommended for inclusion by an expert panel were included in the
employer survey. Respondents were asked to rate how essential each of skills was for future
employability in nutrition and dietetics practice using a four-point scale ranging from 1, not essential to
4, very essential. An option of “unable to answer” also was included.
A cover letter with a link to the questionnaire was emailed to a list of 300 employers whose names
were obtained from an earlier survey requesting RDNs and DTRs provide contact information for
employers. Emails were also sent to Academy of Nutrition and Dietetics dietetic practice group
leadership asking their assistance in encouraging member response. A follow-up reminder email was
sent two weeks later. Individuals were asked to complete the survey themselves and to forward the
request to employers of nutrition and dietetics practitioners.
ACEND worked with Dr. J.T. Johnson, a statistician and director of the Center for Research at the
University of Southern Mississippi, to analyze and interpret data. Descriptive statistics were run for all
variables and inferential statistics were used to compare ratings by demographic variables.
RESULTS
Because of the snowball distribution process, the number of possible respondents is not known. A
total of 300 employers participated in the survey.
Demographic Information
The most common practice setting noted by participants was Healthcare (75.6%) followed by
Community (9.8%) (see Table 6). The settings with the smallest number of participants were
Communications and Media (1.0%) and self-employed (1.0%). Administration was the most frequently
mentioned role (53.6%) followed by Client Care (16.3%). A master’s degree was the most common
(57.4%) education level of participants. Most (96.8%) of the respondents held the RDN credential; 1.1%
held the DTR credential. More than half of the participants (55.7%) had more than 20 years of
experience, followed by those with 10-20 years (23.6%). Responses were received from all regions in
the country. Size of organization was fairly evenly split among organizations of greater than 5000
56
employees (27.9%), 2,001-5,000 employees (21.4%), 501-2000 employees (25.5%) and less than 500
(25.1%). The number of dietitians in the organization varied with greater than 30 (28.1%) and 1-5
(26.4%) being the most common. The number of dietetic technicians was much fewer with 56.4% of
organizations not employing any and 22.3% employing 1-5; only 12.4% employing more than five
dietetic technicians.
Most (90.0%) employers currently require at least a bachelor’s degree and 29.0% currently require a
graduate degree for nutrition and dietetics positions in their organization. Responses to whether they
would require a degree for future nutrition and dietetics positions was divided – 30.9% indicate yes
they would require a graduate degree, 34.6% indicated that they may require a graduate degree and
34.6% indicated they would not require a graduate degree for future positions in nutrition and
dietetics.
Importance of Future Skills
Respondents rated all of the future skills on a four-point scale with 4 being very essential. Most (86%)
of the individual skills had mean ratings greater than three suggesting that skills were essential for
employability in future nutrition and dietetics practice; 22% were rated greater than 3.5 suggesting
they were very essential (see Table 7).
The essential ratings for individual skills within a skill category were averaged to give an overall mean
score for each skill set category (see Table 8). Results suggested that all six skill category sets
(professional research and practice skills; teamwork and communication skills; clinical client care skills;
community and population health skills; leadership, management and organization skills; and food and
foodservice systems) were essential for future employability in nutrition and dietetics practice (i.e.
mean > 3 on 4-point scale) with teamwork and communication skills receiving the highest mean score
(M=3.52) and community and population health skills the lowest mean score (M=3.03).
Analysis of Variance was used to explore differences in skill set scores based on demographic variables
of the respondents (see Table 9). Few statistical differences (p<.05) were found. Those with < 3 years
of experience had the highest mean essential score for the community and population health skill set,
which was higher (p<.05) than the scores for those with more experience. Those in the healthcare
setting had higher (p<.05) essential scores for the clinical client care skill set than those in many other
settings. Those with one to five dietitians in their operation had a higher (p<.05) essential score for the
food and foodservice systems skill set than those with more dietitians. No significant differences in the
essential scores were found based on degree level, role of the employer or number of people employed
in the organization. No significant differences in the essential scores were found based whether the
organization currently required a bachelor’s or graduate degree or whether they expected to require a
graduate degree in the future.
57
Table 6. Demographic characteristics of employers
n
%a
217
75.6%
Community nonprofit
28
9.8%
Educational setting (primary, secondary, university)
13
4.5%
Government (federal, city, state, or local) public health
13
4.5%
Corporate/industry settings (R&D, marketing, sales, etc.)
10
3.5%
Communications and media
3
1.0%
Self-employed consultation or private practice
3
1.0%
Characteristics
Work Setting
Healthcare (hospital, long term care, physician network)
Role
Administration/management
148
53.6%
Client care
45
16.3%
Community/population health
40
14.5%
Foodservice
37
13.4%
1
.4%
Associate’s
4
1.4%
Bachelor’s
111
37.5%
Master’s
170
57.4%
Doctorate
11
3.7%
268
96.8%
DTR or NDTR
3
1.1%
RN
4
1.4%
MD
2
1.1%
3 years or less
24
8.1%
4 to 9 years
37
12.5%
10 to 20 years
70
23.6%
165
55.7%
Research
Highest Degree Held
Credentials Held
RD or RDN
Years of Work Experience
More than 20 years
a
In some cases, total n is greater than total number of responses and percentages total more than 100% as
respondents were allowed to ‘select all that apply’
58
Table 6. (cont.)
Characteristics
%a
n
Region of the Country
Region 1 (AK, CA, HI, ID, MT, OR, WA, WY)
69
23.7%
Region 2 (IA, MI, MN, MO, NE, ND, SD, WI)
24
8.2%
Region 3 (AL, AR, FL, GA, LA, MS, PR, SC)
65
22.3%
Region 4 (AZ, CO, KS, NV, NM, OK, TX, UT)
49
16.8%
Region 5 (IL, IN, OH, WV, KY, TN)
39
13.4%
Region 6 (DE, DC, MD, ND, PA, VA)
26
8.9%
Region 7 (CT, ME, MA, NH, NJ, NY, RI, VT)
19
6.5%
Less than 100 employees
23
7.8%
100-500 employees
51
17.3%
501-2,000 employees
75
25.5%
2,001-5,000 employees
63
21.4%
More than 5,000 employees
82
27.9%
1
.3%
1-5
78
26.7%
6-10
43
14.7%
11-20
65
22.3%
21-30
22
7.5%
More than 30
83
28.4%
167
56.4%
1-5
66
22.3%
6-10
18
6.1%
11-20
9
3.0%
21-30
1
.3%
More than 30
9
3.0%
26
8.8%
Size of Organization
Number of RD/RDNs in Organization
None
Number of DTRs in Organization
None
Unknown
59
Table 7. Employer ratings of skills essential for future employment in nutrition and dietetics practice
Skill
n
Mean a
Std. Dev
Professional Research and Practice Skills

Engage in quality assurance and performance
improvement activities
260
3.66
.542

Collect and interpret data for use in decision making and evaluation
259
3.46
.692

Lead efforts in health, food and nutrition policy development,
implementation and evaluation
258
3.21
.821

Analyze, evaluate and critique scientific studies
260
3.18
.829

Perform data analysis
260
3.00
.854

Design, conduct, analyze and disseminate basic science, clinical
and/or translational research
258
2.78
.879
Teamwork and Communication Skills

Accurately communicate evidence-based information
259
3.77
.483

Participate in team decision making
258
3.72
.516

Use cross cultural skills effectively in communication
258
3.55
.611

Translate dietetics vocabulary across disciplines and in laymen terms
253
3.53
.614

Develops and uses a variety of media and technologies to
communicate messages and education
257
3.49
.638

Lead transdiscplinary, interprofessional and/or interdisciplinary
teams
257
3.44
.677

Employ strategies and facilitate team building
257
3.37
.696

Translate research into materials for consumers
257
3.30
.759
Clinical Client Care Skills
a

Assess nutrition status in clients with a variety of diseases and medical
conditions
247
3.81
.442

Develop, monitor and evaluate nutrition interventions in clients with
a variety of diseases and medical conditions
247
3.75
.541

Diagnose nutrition problems in clients with a variety of diseases and
medical conditions
247
3.75
.541

Counsel clients with multiple diseases/medical conditions and those
who require complex nutrition care using appropriate behavior
change theories and techniques
247
3.71
.506

Prescribe and manage therapeutic diets (renal, cardiac, diabetes,
phenylketonuria)
244
3.71
.559

Prescribe and manage enteral and parenteral nutrition
246
3.69
.641
scale: 1, not essential to 4, very essential for future employability in nutrition and dietetics practice
60
Table 7. (cont.)
Skill
n
Mean a
Std. Dev
Clinical Client Care Skills (cont.)

Interview clients for nutrition risk and diet history
245
3.60
.603

Provide nutrition care for clients who have multiple diseases/medical
conditions and complex nutrition and health needs (e.g. palliative
and hospice care, oncology, high risk pregnancy)
246
3.60
.575

Analyze food intake in clients with a variety of diseases and medical
conditions
247
3.52
.674

Implement designated dietary interventions based on protocol
247
3.49
.680

Educate clients in health maintenance and disease prevention
243
3.48
.632

Assess individual’s physical, social and cultural needs
246
3.46
.697

Perform calculations for risk assessment following protocol
243
3.44
.698

Write nutrition orders for nutrition supplements, vitamins
and minerals
245
3.42
.784

Counsel clients affected with disorders that are serious in nature,
including eating disorders
246
3.40
.673

Apply integrative nutrition principles to nutrition care and Medical
Nutrition Therapy (MNT), including the use of nutritional genomics,
dietary supplements and/or herbal remedies
247
3.38
.760

Conduct nutrition focused physical exams as part of assessment
246
3.33
.800

identify sociological, psychological and environmental influences on
eating behavior
246
3.32
.733

Order nutrition related laboratory tests
242
3.17
.883

Counsel clients on appropriate ways and methods to increase physical
activity
245
3.14
.739

Manage nutrition related medication of clients
243
3.14
.830

Perform routine tests (e.g. finger prick for blood glucose, urine
analysis) to assess and monitor clients’ nutrition and health status
242
2.54
.994
Community and Population Health

Serve as a nutrition resource for community organizations
245
3.34
.750

Provide nutrition and lifestyle education to well populations
241
3.27
.783

Design and implement culturally appropriate nutritional initiatives
and programs
240
3.10
.852

Interpret and use national nutrition surveillance data and
population• based statistical data
242
3.05
.790

Interpret basic population based statistical data
239
3.05
.782
61
Table 7. (cont.)
Skill
n
Mean a
Std. Dev
Community and Population Health (cont.)

Convene and mobilize community partnerships and coalitions to
identify and solve food, nutrition and/or health related issues by
building on community assets and focusing on policy, systems and
environmental strategies
237
2.95
.874

Assess the need to develop and implement a community or
population health program and/or intervention considering
biological, behavioral, psychological, social, economic, policy and/or
environmental factors
239
2.94
.868

Develop and evaluate policies, laws and regulations that address and
protect health and nutrition for individuals and populations
240
2.85
.882

Conduct culinary demonstrations to teach cooking skills, safe food
handling practices and promote consumption of healthy foods
242
2.77
.913
Food and Foodservice Systems Skills

Develop menus and standardized recipes for diverse groups for
normal and therapeutic diets applying principles of menu planning
and knowledge of medical nutrition therapy and therapeutic
nutrition
243
3.33
.781

Complete nutrient analysis of food products, recipes and menus
243
3.30
.759

Conduct operational analyses and streamline operations to reduce
costs while ensuring health related goals are not compromised
242
3.21
.899

Manage production and service of food that meets nutrition
guidelines, cost parameters and health needs
243
3.16
.892

Plan and implement food safety and sanitation programs
240
3.16
.942

Teach others how to prepare healthy foods using knowledge of food
science and culinary techniques
241
3.10
.836

Manage food distribution and service ensuring accuracy, quality and
portion control
242
3.05
.950

Evaluate purchasing needs and develop specifications for food and
equipment
239
2.92
.953

Negotiate purchases and contracts for products and services
240
2.75
1.024
62
Table 7. (cont.)
Skill
n
Mean a
Std. Dev
Leadership, Management and Organizational Skills

Lead process improvement activities to improve delivery of food and
nutrition services
245
3.48
.761

Demonstrate conflict resolution and mediation skills
241
3.35
.771

Manage staffing functions such as interviewing, hiring, motivating,
supervising, evaluating and terminating employees
243
3.35
.776

Develop operational policies, procedures, job descriptions, work
schedules and performance standards
244
3.32
.778

Conduct employee performance evaluations and counsel employees
for performance improvement
242
3.27
.805

Adjust operations based on financial performance
243
3.25
.898

Identify opportunities for increasing revenue
242
3.20
.913

Develop emergency preparedness plans for facilities, patients/clients
and/or communities
243
3.07
.854

Direct strategic planning
243
3.07
.909

Develop operational and capital budgets
243
3.05
.937

Develop business plans to sell ideas and turn ideas into action
243
3.03
.955

Advocate for changes in policies to improve access to food and
nutrition services for the public
242
3.03
.940

Lead initiatives to improve use of sustainable practices in food and
nutrition services
242
2.99
.942

Develop, implement and evaluate marketing plans for new products,
programs and services
243
2.96
.974
63
Table 8. Skill set essential scores
n
Mean a
Std. Dev
Teamwork and Communication Skills
259
3.52
.389
Clinical Client Care Skills
248
3.44
.444
Professional Research and Practice Skills
262
3.25
.465
Leadership, Management and Organizational Skills
246
3.17
.682
Food and Foodservice Systems Skills
243
3.11
.727
Community and Population Health Skills
246
3.03
.661
Skill Set
a
scale: 1, not essential to 4, very essential for future employability in nutrition and dietetics practice
64
Table 9. Comparison of employer mean essential scores based on demographic data
Skill Seta
Characteristic
Research
Client Care
Community
Teamwork
n
Mb ± SD
n
Mb ± SD
n
Mb ± SD
n
Mb ± SD
Leadership
n
Mb ± SD
Foodservice
n
Mb ± SD
Setting
Healthcare
Education
Community
Government
Corporate
Communications
Self Employed
191
12
24
12
10
2
2
3.26 ± .464
3.34 ± .423
3.06 ± .469
3.17 ± .457
3.40 ± .367
3.36 ± .909
3.64 ± .101
182
12
23
12
9
1
2
3.49 ± .381x
3.13 ± .850y
3.39 ± .569xz
3.32 ± .414z
3.21 ± .545z
3.90
3.20 ± .096z
176
12
22
12
10
2
2
2.99 ± .666
3.10 ± .489
3.25 ± .499
3.06 ± .750
3.67 ± .157
3.67 ± .157
3.17 ± .393
188
12
24
12
10
2
2
3.51 ± .384
3.53 ± .413
3.49 ± .443
3.50 ± .392
3.48 ± .337
3.94 ± .008
3.87 ± .177
178
12
21
12
10
2
2
3.18 ± .669
3.32 ± .790
3.02 ± .587
3.11 ± .729
3.12 ± .732
4.00 ± .000
3.79 ± .303
177
11
21
12
9
2
2
3.13 ± .654
3.29 ± .910
3.07 ± .906
2.85 ± 1.10
2.93 ± .752
3.16 ± .403
2.94 ± .550
Level of Education
Associate
Bachelor’s
Master’s
Doctorate
4
101
147
10
3.21 ± .247
3.28 ± .433
3.25 ± .476
3.08 ± .676
4
98
136
10
3.58 ± .542
3.44 ± .506
3.45 ± .391
3.35 ± .489
4
94
136
10
3.14 ± 1.01
3.03 ± .649
3.03 ± .670
2.94 ± .620
4
102
143
10
3.28 ± .329
3.52 ± .389
3.54 ± .367
3.26 ± .605
4
95
136
10
3.36 ± .707
3.13 ± .636
3.22 ± .689
2.76 ± .913
4
95
134
9
3.25 ± .618
3.16 ± .751
3.09 ± .702
2.70 ±.870
23
31
63
145
3.30 ± .455
3.25 ± .432
3.19 ± .508
3.27 ± .456
23
26
57
142
3.58 ± .636
3.42 ± .477
3.37 ± .493
3.46 ± .374
23
29
55
137
3.38 ± .556y
3.10 ± .670z
3.02 ± .602z
2.96 ± .686z
23
30
63
143
3.62 ± .335
3.47 ± .435
3.42 ± .421
3.55 ± .366
22
29
56
138
3.38 ± .492
2.99 ± .593
3.06 ± .725
3.22 ± .698
22
28
55
137
3.42 ± .636x
2.86 ± .759y
3.04 ± .815z
3.14 ± .683z
2.98 ± .633
3.13 ± .735
3.04 ± .696
3.20 ± .600
2.89 ± .385
132
38
31
35
4
3.53 ± .369
3.56 ± .384
3.54 ± .399
3.47 ± .456
3.22 ± .524
124
37
29
32
4
3.15 ± .670
3.27 ± .711
3.36 ± .574
2.96 ± .672
3.14 ± .883
122
37
29
32
3
3.11 ± .679
3.30 ± .612
3.28 ± .620
2.86 ± .982
3.00 ± .667
Years of Work
Experience
3 or less
4-9
10-20
More than 20
Position
Administration
Client Care
Foodservice
Community
Education
133
40
31
35
4
3.26 ± .450
3.25 ± .490
3.42 ± .419
3.09 ± .493
3.07 ± .429
126
37
29
33
4
3.46 ± .406
3.55 ± .333
3.44 ± .576
3.44 ± .576
3.48 ± .422
124
37
28
33
4
a Skill
Sets include: professional research and practice skills; clinical client care skills; community and population health skills; teamwork and communication skills; leadership,
management and organization skills; and food and foodservice systems.
b Scale:
1, not essential to 4, very essential; values within a characteristic column grouping with dissimilar superscript letters (x,y,z) differ significantly (p<.05).
65
Table 9. (cont.)
Characteristic
Research
n
Ma ± SD
Client Care
n
Ma ± SD
Skill Seta
Community
Teamwork
a
n
M ± SD
n
Ma ± SD
Leadership
n
Ma ± SD
Foodservice
n
Ma ± SD
Organization Size
<100 employees
100-500
501-2,000
2,001-5,000
>5,000
18
44
67
58
73
3.34 ± .432
3.24 ± .459
3.16 ± .462
3.31 ± .446
3.27 ± .498
16
39
66
54
71
3.39 ± .356
3.41 ± .537
3.38 ± .523
3.53 ± .336
3.48 ± .394
17
40
63
53
69
3.18 ± .676
3.26 ± .590
3.38 ± .523
3.53 ± .336
3.48 ± .394
19
42
67
56
73
3.56 ± .315
3.51 ± 3425
3.50 ± .419
3.55 ± .358
3.50 ± .385
17
39
64
53
70
3.21 ± .626
3.28 ±.702
3.15 ± .694
3.15 ± .692
3.12 ± .676
16
39
64
53
69
3.06 ± .539
3.31 ± .679
3.12 ± .840
3.04 ± .720
3.05 ± .686
Number of RDNs
1-5
6-10
11-20
21-30
>30
69
38
60
16
74
3.27 ± .463
3.18 ± .395
3.33 ± .533
3.35 ± .430
3.19 ± .441
63
36
56
15
73
3.47 ± .476
3.36 ± .438
3.50 ± .361
3.53 ± .377
3.42 ± .486
63
35
56
14
71
3.19 ± .387
2.87 ± .582
3.04 ± .683
2.85 ± .594
3.00 ± .670
69
36
59
16
74
3.49 ± .395
3.51 ± .323
3.55 ± .435
3.53 ± .321
3.53 ± .377
65
35
55
15
71
3.33 ± .693
2.90 ± .713
3.17 ± .722
3.10 ± .621
3.15 ± .621
64
35
55
15
69
3.33 ± .664x
2.89 ± .820y
3.15 ± .640y
2.93 ± .739y
3.01 ± .752y
Currently Require
Bachelor Degree
Yes
No
220
24
3.27 ± .465
3.24 ± .429
218
25
3.46 ± .412
3.37 ± .582
218
25
3.02 ± 0674
3.13 ± .571
219
26
3.51 ± .399
3.58 ± .318
221
25
3.16 ± .689
3.29 ± .618
219
24
3.09 ± .739
3.25 ± .594
Currently Require
Graduate Degree
Yes
No
70
173
3.24 ± .495
3.27 ± .446
70
172
3.45 ± .457
3.45 ± .423
71
171
2.99 ± .712
3.05 ± .645
70
173
3.52 ± .461
3.51 ± .361
71
174
3.16 ± .721
3.18 ± .669
71
171
3.04 ± .720
3.13 ± .730
Expect to Require
Graduate Degree
Yes
No
75
82
3.34 ± .490
3.23 ± .439
73
83
3.52 ± .406
3.46 ± .419
75
81
3.16 ± .619
3.04 ± .687
73
84
3.59 ± .429
3.48 ± .372
75
84
3.20 ± .763
3.17 ± .682
72
84
3.05 ± .759
3.17 ± .761
66
COMPETENCY GAP ANALYSIS
By Leanne Worsfold, RN, iComp Consulting
PURPOSE
The purpose of this project was to gather information from educators, preceptors, practitioners and
employers and determine whether there were gaps in the competencies required in the current 2012
ACEND® program accreditation standards for each program type (didactic program in dietetics, dietetic
internship program, coordinated programs in dietetics and dietetic technician program).
METHODOLOGY
Open-ended and probing questions were used to gather feedback from participants in four focus groups
regarding the identified gaps and required enhancement to the competencies in an effort to determine
the minimum expectation of the student entering current and future practice in nutrition and dietetics.
RESULTS
A total of 12 educators, 9 practitioners (several of whom were employers) and 6 preceptors participated
in the two hour long focus groups. Several themes emerged from the discussions: Master’s level
education for RDNs was well supported; a need for more time for application of knowledge and
demonstration of skills (practical experience) in the programs; inconsistency in the programs and
internship expectation; undergraduate program must include transferable skills for other professional
direction (e.g. leadership, business, management); graduate level could offer specialization and the need
for an increased number of RDNs teaching the programs; and concerns with students obtaining
internship placements and inconsistency with internship expectations. The findings addressing specific
gaps in competencies are detailed in Table 10.
67
Table 10. Gaps in competencies in 2012 ACEND Accreditation Standards
Domain
Perceived Gaps in Competencies
Scientific and Evidence Base of
Practice: integration of scientific
•
•
•
•
•
•
•
Interpretation of research and basic terms
Syntheses and analysis of information
Critically evaluate research
Interdisciplinary research focus
Communications skills related to knowledge transfer
Use of technology (database)
Submission of Institutional Review Board forms – graduate level
•
•
•
•
•
Cultural communications
Written and verbal communication skills
Determinates of health and diversity
Health law – add application of applicable legislation
Motivational interviewing
•
•
•
•
•
•
•
•
•
Knowledge of medical terminology
Critical thinking and decision-making
Cultural care
Industry/business competencies
Food preparation and culinary skills
Population health focus – graduate level
Supply chain management (more than just procurement)
Sustainability, recycling and waste (aeroculture and globalization)
Medical Nutrition Therapy – intervention/treatment
•
•
•
•
•
•
•
•
Psychology
Anatomy
Epidemiology - graduate level
General management and business principles (e.g. economics)
Ethics – health related
Math skills
Critical thinking
Food preparation indicators (move to another unit)
information and research into
practice
Professional Practice
Expectations: beliefs, values,
attitudes and behaviors for the
professional dietitian level of
practice.
Clinical and Customer Services:
development and delivery of
information, products and services
to individuals, groups and
populations.
Support Knowledge: knowledge
underlying the requirements
specified above.
68
STAKEHOLDER INPUT ON FUTURE MODEL RECOMMENDATIONS
By Christopher Buonincontri, MA
EXECUTIVE SUMMARY
Findings from the content analysis of the ACEND Education Model Feedback Survey are presented.
Resultant themes varied widely, though more concerns were expressed than benefits. The most
common perceived benefits of the proposed model were increased prestige among dietitians, elevation
of the field to match the requirements of peer professions, increased knowledge and skill, and new
career pathways. Prime concerns included compensation issues, job and internship availability, lack of
justification for new requirements, cost to students and institutions, blurred delineation between levels,
and adverse impact. Considerations and limitations based on the nature of the data are briefly
discussed. A Frequently Asked Questions (FAQ) document to address questions and concerns in
included in Appendix E
PURPOSE
The purpose of this project was to gather information from various stakeholders to determine reactions
to the recommended future education model.
METHODOLOGY
ACEND® conducted an online survey to gather stakeholder comments related the recommended future
model for an associate’s degree program for community nutrition and health assistants, a bachelor’s
degree program for nutrition and dietetics technicians, and a master’s degree for dietitian nutritionists. A
copy of the questionnaire is included in Appendix F. A total of 7,366 comments were reviewed; 3,671
from (50%) nutrition and dietetics practitioners, 2,150 (30%) from educators, 688 (9%) from
students/interns, 460 (6%) employers, and 397 (5%) education or healthcare administrators.
Responses were assigned codes and grouped together, listed under either Benefits or Concerns within
one of four topics: the Master’s Degree for Dietitian Nutritionist, the Bachelor’s Degree for Nutrition and
Dietetics Technician, the Associate’s Degree for Community Nutrition and Health Assistant (now termed
Nutrition Health Worker), or the entire model. Major and minor themes were identified, with “major”
defined as 25 or more weighted responses, and “minor” as between 5 and 25 responses. General
“perceived strengths,” “concerns,” and “additional comments” were coded distinctly at first but later
grouped in with the first three topics, as all significant themes identified under them were redundant
with those previously listed. Groupings were re-analyzed and subdivided or consolidated as more and
more data was reviewed (deductive and inductive analysis).
Given that the overall response rate was much higher among the “Educator of Nutrition and Dietetics
Practitioner” and “Nutrition and Dietetics Practitioner” groups, it was necessary to include weighted
adjustments when comparing response prevalence per theme. Despite this, the small sample sizes of
the “Healthcare Administrator” and “Education Administrator” groups all but precluded identification of
any themes. Additionally, it is difficult to say whether themes associated with Educators and
Practitioners are truly specific to those groups or would otherwise have been emphasized by other
groups as well.
69
Sample bias may have colored the results obtained from this survey. Many of the responses were
emphatic and polarized, indicating that only those with strong opinions participated—a large number of
others who may have been pleased or unconcerned with the proposed changes may simply have not
bothered to complete the survey. Other unknown factors may also have limited the sample of
respondents, though this is impossible to ascertain without additional information.
Additional biases may have affected results, including response bias stemming from elements or cues
within the preceding webinar. Some respondents also expressed confusion and misunderstanding of the
material presented.
RESULTS
Overview of Findings
The responses analyzed were thoroughly mixed in terms of opinion, level of detail, and enthusiasm. The
majority included concerns instead of benefits, and many focused on the master’s degree prepared
dietitian nutritionist rather than the bachelor’s degree prepared nutrition and dietetics technician or the
associate’s degree prepared community nutrition and health assistant (now termed nutrition health
worker), positions. Concerns were generally lengthier and expressed in more detail than perceived
benefits. The most popular themes were often counterbalanced by less popular, complementarily
opposing ones (e.g. predictions that salaries would increase versus others predicting they would not).
The most salient theme by far was concern for compensation levels, and the negative impact (or lack of
positive change) the model would have in this regard. This was part of a larger monetary concern
including cost of education; increased costs without future return on investment was predicted to lead
to loss of talent and fewer dietitian nutritionists overall, raising additional concerns over adverse impact
(the field would be limited to “affluent white women”). Respondents also suggested that current low
levels of job and internship availability would be exacerbated by implementation of the model.
The most cited benefit of the new master’s requirement was increased respect by other allied
healthcare professions. Many alluded to these other fields as having set a necessary precedent, and
encouraged dietetics to follow suit. The anticipated education requirements were viewed as a benefit to
many, elevating the expertise throughout the field; others claimed they are unnecessary, and that
experience is more valuable than time in the classroom. Some stated that master’s level practitioners
should be specialized instead of “generalists,” and a few suggested doctoral degree prepared as
specialists in addition to the proposed model. Educators expressed concern over implementation at
their institutions, referencing high cost and a dearth of qualified instructors.
Competition among the three new roles was a recurring concern, related to employer (and public)
confusion as to what the different skill sets and requirements of each would be. Lack of clarity raised
the issue of job creation/availability, and employment of newly available under-qualified individuals
(which would cost employers less) instead of Registered Dietitian Nutritionists (RDN). Respondents
called for increased marketing efforts in an effort to solve this problem. Critics predicted dilution of the
field and reliance on inadequate expertise.
Some saw the overall model as beneficial, providing new roles that would fill identified needs and job
70
demand, as well as a logical career pathway. More, however, doubted that this would be the case,
predicting competition between roles, friction between professionals with the same position but
different levels of education and experience, and many of the issues previously mentioned. Difference
in response prevalence among stakeholders is noted below each description.
Master’s Degree for Dietitian Nutritionist
Benefits (Major Themes)
Respect, Credibility, Prestige. The most prevalent benefit noted was the increased credibility gained by a
master’s degree requirement. Respondents indicated that other healthcare professions do not respect
them as experts in the field, and that elevating the profession by mandating higher education would
rectify this. Emphasized by all groups, especially Students.
Comparison with Other Fields. Highly related to the theme above, many respondents cited
effectiveness of similar models in other healthcare professions, particularly nurses and physical
therapists. Emphasized by Educators, Employers and Practitioners.
Increased Knowledge. Respondents indicated that a broader level of knowledge would be a beneficial
product of the new degree requirement. Emphasized across all groups.
Specific Graduate Degree Skills. Responses included certain skills that graduates would gain from a
master’s level education. Most commonly mentioned were research skills, followed by critical thinking
skills, management skills, and communication skills. Emphasized by Educators and Practitioners.
Increased Salaries. A significant number of respondents anticipated higher salaries following the
master’s requirement. It should be noted that more responses indicated doubts that this would be the
case. Emphasized by Practitioners, Students and Educators.
Benefits (Minor Themes)
Reduce Crowded Field. Some respondents indicated that the new master’s degree requirements would
“reduce the influx of RDNs,” regulating some of the high demand for jobs and internships and, in turn,
possibly leading to higher salaries in the long run. Interestingly, an almost equal number of responses
predicted negative consequences of this outcome. Emphasized by Practitioners.
PhD Recommended for Specialists. A portion of participants who applauded the current model
recommended that a doctoral degree be required for specialists in the field, following the example of
other healthcare professions (e.g. physical therapists). Emphasized by Educators, Practitioners.
Concerns (Major Themes)
Compensation Issues. The most common theme among concerns of the new model centered on
compensation issues: that is, worries about current and future salary levels. Respondents expressed
doubts that salaries would increase commensurate with higher qualifications, as well as expressing
dissatisfaction with current salary levels. Heavily coinciding with “Cost of Degree,” the two themes
combine into an overarching concern for Return on Investment of the degree. Some also cited concern
over lack of reimbursement under the current model, which may not improve (or worsen) post-changes.
71
Emphasized across all groups.
Cost of Degree. Both the expense and time required for the master’s concerned a large portion of
respondents. Emphasized across all groups.
Adverse Impact. Concerns that higher education requirements would prevent minorities from entering
the field were most common for the master’s degree section. Predictably, these responses highly
coincided with concerns over the cost of the degree. The dietetics field was repeatedly cited as being
dominated by white women. Concerns that the requirements would deter men from the field were also
expressed, though much less common. Emphasized by Educators, Practitioners.
Educational Institution Concerns. These concerns centered on problems with implementation of the
new master’s program at educational institutions. The most common concerns were availability of
qualified instructors at the doctoral level and available funds. Additional concerns included: impact on
existing undergraduate programs, institutional buy-in, closure of programs, and time required for
implementation. Emphasized almost exclusively by Educators, Educational Administrators.
Job Availability. Respondents expressed concern that there would be low demand for the new master’s
degree position as described. Many also indicated that, as the new position would demand a higher
salary, employers are likely to hire less qualified (i.e. bachelor degree) job candidates instead.
Emphasized most by Employers, Practitioners.
Diluting the Field. Responses related concern that requiring a generalist master’s degree would both
devalue current practitioners at the master’s level, and water down the degree (related to concern that
the degree should be specialized instead of general). Institutions would be forced to condense too much
material into a two year curriculum. Emphasized most by Educators, and some Practitioners.
Internship Availability. Many expressed concern that the already scarce number of internships would be
in even higher demand under the new model. Some decried use of distance internships, and worried
that widespread use of this would allow unqualified professional into the field. Emphasized most by
Educators.
72
Concerns (Major Themes) (cont.)
Master’s Unnecessary. The concerns expressed under this category represented a number of
interrelated subthemes. Primary among them, respondents indicated that a master’s level professional
should specialize in a particular area rather than work as a generalist, which is appropriate for the
bachelor’s level. Specialization would make the position more attractive to employers. Some raised
concerns that the master’s degree and bachelor’s degree prepared RDNs would essentially be the same.
It was noted that the general nutrition master’s degree would be appropriate for those changing
careers, though these individuals may be less qualified without the foundation of the bachelor’s degree.
Emphasized by Educators, Employers, Practitioners, Students.
Another concern regarded the value of experience over education. One respondent put it succinctly: “a
Bachelor’s degree with experience is more beneficial than a Master’s degree.” Many cited the internship
as more “valuable” than the master’s degree. Some indicated that higher-level education is only needed
for some RDN positions and not others; others claimed that needed skills, such as management skills,
would not be provided by master’s training. Emphasized by Educators, Employers, Practitioners.
Concerns (Minor Themes)
Fewer Dietitians. Related to adverse impact, participants expressed concern that the new requirements
would reduce the number of practitioners overall, pushing qualified students to pursue other career
paths with better return on investment. Emphasized by Educators, Practitioners.
Premature Career Choices. Respondents raised concern as to whether it is wise to force students to
begin their master’s without having experience in the field first. Many stated that students should not
be faced with the decision of what to specialize in straight out of their undergraduate program, as they
would be less likely to make informed decisions that early in their career. Some also suggested that it
would be better to mandate a master’s degree while working in the field (i.e. within five or ten years),
following other professions’ examples. Emphasized by Educators, Practitioners, Students.
Title / Branding. Many responses indicated concern that the new title itself would both confuse the
public and undermine the value of the position. Emphasized by Educators, Practitioners, Students
CUP. Some respondents suggested incorporation of Coordinated Undergraduate Programs, citing their
effectiveness. Emphasized by Employers, Practitioners.
Degrees in Other Fields. A small but significant number of responses indicated concern with accepting
individuals with master’s degrees in unrelated fields into programs, some adding that prerequisites
should be mandated. Relatedly, others were confused as to whether such individuals would be accepted
under the new model. Emphasized by Employers, Practitioners.
Marketing Importance. This was cited with regard to all three roles, and the model in general.
Respondents stressed the importance of clearly defining and marketing the roles to employers, affiliates
and the public. Emphasized by Educators, Employers, Practitioners.
73
Concerns (Minor Themes) (cont.)
Degree Creep. Participants described the current situation using the term “degree creep,” or the
practice of requiring higher-level degrees for the same job. This was repeated with regard to the other
positions as well. This is related to concerns over increased cost to student, adverse impact and
restricting overall number of dietitians in the field. Emphasized by Employers, Healthcare
Administrators, Practitioners, Students.
Bachelor’s Degree for Nutrition and Dietetics Technician
Benefits (Major Themes)
Additional Career Options. Respondents cited a wider array of possible career options, due to the new
positions, as an important benefit of the new model. The bachelor’s degree nutrition and dietetics
technician position would be available to those who either could not or do not want to pursue an
internship. Additionally, it would serve as another step in the “career ladder” within the field.
Emphasized across all groups.
Increased Knowledge. Similar to the theme identified regarding the master’s requirement, participants
stated more knowledge and higher general skill level would be a positive move for the profession.
Emphasized by all groups.
Benefits (Minor Themes)
Increased Salaries. Similar to those indicating that the new master’s requirement would correspond to
increased salaries, some stated that the new bachelor’s degree would lead to higher compensation.
Emphasized across all groups.
Bachelor’s Requirement is Appropriate. Respondents indicated that the degree requirement is
generally appropriate given the nature of the role. Emphasized by Educators, Practitioners, and
especially Students.
Better Support for RDNs. Survey participants suggested that bachelor’s degree nutrition and dietetics
technician would provide better quality support for dietitians. Emphasized by Employers, Practitioners.
Compensation Issues. Responses regarding compensation issues described in the master’s section
above were echoed for this position. Some indicated that the bachelor’s degree would make nutrition
and dietetics technicians (identified by many as highly similar to current DTRs) overqualified for the low
pay they would receive. Emphasized by Educators, Employers, Practitioners, Students.
Job Availability, Hiring Issues. Many listed concerns that employer demand for the bachelor’s degree
nutrition and dietetics technician would be low for various reasons. Some cited that facilities would not
have the budget to include both an NDTR and RDB: thus, either NDTRs will not be hired, or will be
brought on to replace RDNs. Emphasized by all groups.
74
Concerns (Major Themes)
Competitions Between Roles. Related to the hiring issues noted above, competition among the new
roles was a prevalent concern among responses. Apart from competition with RDNs, some were
concerned that entry-level nutrition and dietetics technicians would compete with current NDTRs,
eventually phasing out the profession altogether. Emphasized across all groups.
Name / Branding. Respondents expressed concerns over the name of the new position (“technician”
was widely cited as inappropriate for a bachelor’s degree holder). Additionally, the name and defined
role were described as potentially confusing to the public and potential employers. This is related to
concern over employers hiring lower level positions, who may be more likely to hire less expensive
candidates if unclear regarding the expertise and function of the various new roles. Emphasized by all
groups.
Cost of Degree. Highly related to compensation issues, and thus concern with overall return on
investment of degree. Emphasized across all groups.
Same as Current DTR. Related to degree creep, many indicated that the bachelor’s level nutrition and
dietetics technician position as described would be the same as the current NDTR role. Others stated
that a two-year degree was satisfactory preparation for this new role, as it is for the NDTR currently.
Generally, there was some confusion regarding the bachelor’s level nutrition and dietetics technician
position job description, especially set alongside current RDNs and NDTRs (related to “competition
among roles,” above). Emphasized across all groups
Concerns (Minor Themes)
Independence from RDNs. Concern was expressed as to whether bachelor’s level NDTRs would work
independent of RDN supervision. Some thought this should be mandated, though others indicated scope
of responsibilities would vary by setting, circumstance, etc. Emphasized by Educators, Practitioners.
Supervised Practice Availability. Respondents were concerned with preceptor availability for supervised
practice at this level, considering the current shortage. Emphasized by Educators, Practitioners.
Degree Creep. Participants described the current situation using the term “degree creep,” or the
practice of requiring higher-level degrees for the same job. This was repeated with regard to the other
positions as well. This is related to concerns over increased cost to student, adverse impact and
restricting overall number of dietitians in the field. Emphasized by Employers, Healthcare
Administrators, Practitioners, Students.
Diluting the Field. Concern was expressed that bachelor’s degree nutrition and dietetics technicians
would replace RDNs in many settings, thus comprehensively lowering the qualifications of the dietetic
workforce and weakening the profession. Emphasized by Educators, Practitioners.
75
Associate’s Degree for Community Nutrition and Health Assistant (now termed Nutrition
Health Worker)
Benefits (Major Themes)
New Role in Career Ladder. Respondents stated this would be a beneficial addition to the dietetics
career ladder for a number of possible reasons, including creation of more jobs, opportunities for lowerlevel graduates, and a pipeline to bolster the field overall. Emphasized across all groups.
Increased Knowledge. Many respondents indicated that the new education requirements are
appropriate for the position. Emphasized by Practitioners.
Benefits (Minor Themes)
Provide Needed Services. Respondents suggested that the new community nutrition and health
assistant (CNHA) role would provide much needed services, and thus serve as a beneficial addition to
the model. Examples included work in healthcare settings (conducting preliminary health screenings), in
food service systems, with WIC, and in schools. Emphasized by Educators, Practitioners.
Concerns (Major Themes)
Role Clarity. Survey participants expressed concern and confusion as to the definition of this role, in
terms of what the job would look like in practice and what skill sets incumbents would have. Emphasized
across all groups.
Title / Branding. Respondents were concerned that the CNHA title was “degrading.” The term
“assistant” is commonly used for those without degrees, and AS degree holders would be appropriately
titled “technicians.” Many others cited the title as “confusing” and “cumbersome.” Emphasized by
Educators, Practitioners.
Diluting the Field. Respondents expressed concern that the role itself was “diluted,” and that inclusion
of a professional at this level would have a negative impact on RDNs and “water down the profession.”
This is related to scope of practice, and delineation/competition between roles. Emphasized by
Educators, Employers, Practitioners.
Too Many Levels. Respondents indicated that inclusion of the CNHA position would bring too many
levels to the dietetic career structure, confusing the public and employers as well as fostering
competition among the newly created roles. Emphasized most by Practitioners.
Job Availability. Many participants related concerns that there would be no demand among employers
for the new position. Emphasized across all groups (except Healthcare Admins).
Compensation Issues. Corresponds to theme described above in the master’s section. Emphasized
across all groups, especially Practitioners.
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Concerns (Minor Themes)
Competition Between Roles. Participants expressed concern that positions would compete for scarce
jobs: some believed that it would be difficult for CNHAs to compete with bachelor’s degree holders, but
most asserted that CNHAs would take the jobs of more qualified professionals as employers tried to cut
costs. This is highly related to job availability. Emphasized by Educators, Practitioners, Students.
Role Should Require Bachelor’s. Respondents indicated that the CNHA role should require a four-year
degree. Sending professionals with lower qualifications into the field to educate the public would serve
to disseminate misinformation in an already largely misunderstood field. Others thought it would be
better to require certification or licensure instead. Emphasized by Educators, Employers, Practitioners,
Students.
RDN Supervision. Some concern was noted regarding whether CNHAs would be under RDN supervision,
for reasons similar to why others expressed they should need a Bachelor’s degree (see above).
77
ADDITIONAL INFORMATION GATHERED IN THE
DEVELOPMENT OF THE FUTURE EDUCATION MODEL
STANDARDS AND COMPETENCIES
Associate Degree Nutrition Health Worker
Assessment of the 2012 ACEND® Accreditation Standards
78
ASSOCIATE DEGREE NUTRITION HEALTH WORKER
By Leanne Worsfold
PURPOSE
In February 2015, ACEND® released recommendations for the future education of nutrition and
dietetics practitioners. That model included a recommendation for an associate’s degree prepared
practitioner initially titled, community nutrition assistant. After release of the document, many
questions were raised about the type of work this practitioner would do. The purpose of this project
was to collect additional data to better understand the possible role of an associate’s degree prepared
nutrition and dietetics practitioner in a community setting.
METHODOLOGY
Consultant, Leanne Worsfold, conducted two focus groups with 17 registered dietitian nutritionists
(RDN) who worked in community and population health to explore the current role and responsibilities
of nutrition and dietetic professionals working in community and population health positions. In
addition, she conducted two structured, in-depth interviews with two individuals who have provided
leadership to community health initiatives: Carl Rush, MRP, who provides leadership for the Project on
Community Health Worker (CHW) Policy and Practice at the University of Texas Institute for Health
Policy and Laura Bahena, who is on the American Public Health Association CHW Governing Council and
works for the Illinois Department of Public Health Office of Minority Health. The interviews explored the
roles and responsibilities of the community support worker (CSW) and discussed the future role and
responsibilities of the potential community nutrition assistant.
RESULTS
Focus Groups
Focus group participants discussed distinctions between the community and population health RDN
prepared at the baccalaureate and master’s level. Participants described how community support
workers are utilized in communities such as Native American and Hispanic communities as peer support
workers. The anticipated roles and responsibilities and competence needed were identified.
Anticipated Roles and Responsibilities for Community Support Worker
 Focuses on health promotion and monitoring plan of care
 Works in collaboration with and under the supervision of RDNs (with Masters level)
 Demonstrates food preparation skills
 Provides support for the elderly, older adult, child and maternal health groups
 Assists with diabetic education programs and school-based education
 Builds relationships in the community
 Collects basic assessment data (Hemoglobin, BP, blood glucose level, weight)
79
Skills Needed
 education principles
 geriatric and pediatric health
 communication skills
 culinary skills
 knowledge of special diets




menu planning
physiology and disease states
safe food preparation and storage
food insecurities
Structured Interviews
Participants in the structured interviews stressed that the effectiveness of the role of the community
worker is based on the community relationship and social and economic balance. These workers were
described as being most effective when they resided within the local community and were able to share
life experiences. Many individuals in this role see it as a "calling" versus a job or a profession. The main
role for the community worker was thought to be providing support for compliance, acceptance and
management of nutritional, physical and mental health concerns for health promotion. The role and the
training for this practitioner currently is not standardized and can range from a high school diploma (for
the most part) to a certificate or AA in a health related field.
Anticipated Roles and Responsibilities for Community Support Worker
 Creates a positive experience and relationship with the client
 Acts as a patient and community advocate
 Counsels and assists clients to deal with personal and social problems
 Keeps the client out of the hospital by supporting regular visits to their primary physician
 Keeps clients actively engaged with their primary physician
 Supports the client to ensure pick-up of their prescription medications
 Proactively engages the client to manage their care
 Provides client education using predefined and pre-developed learning plans and education
materials
 Supports transitions of care
 Helps to keep clients compliant with their care plans
 Partners with care team (community, providers, internal staff)
 Is knowledgeable and continues learning of community cultures and values
 Conducts assessments using standardized templates
 Offers information and resources
 Supports development of education materials
 Undertakes activities to enable people to address their own health and well-being needs
consistent with the plan of care
 Facilitate and encourages the development of skills in the following areas: activities of daily
living, interpersonal coping, socialization, & community functioning
 Supports the individual and the family in crisis situations; provides personalized interventions to
develop, facilitate, or enhance an individual's ability to make informed and independent
decisions
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






Facilitates self-motivational skills
Conducts assessments of the environment
Monitors plans of care
Collects assessment data - weight, BMI, gait assessment, activity level
Engages client in motivation interviewing
Monitors diabetes management - blood glucose level, education
Collects research data
Skills Specific to Nutrition and Dietetics
 very practical skills focused on food and meals versus nutrients and nutrition
 grocery store tours
 culinary skills
 dietary monitoring
 counseling, coaching and motivation skills
 informing and enabling
 outreach
 label reading
 recipe sharing
Skills Needed
 advocacy skills
 health systems and structure/
community agencies
 cultural influence, values and beliefs
 behavior change, counseling theories
and interviewing skills
 determines of health and impact on
care and the community
 life-span psychology and developmental
 problem solving skill
 professional behaviors and therapeutic
relationship
 communication skills
 presentation skills
 learning process
 mentoring and coaching
 motivational learning and behavioral
change
 basic dietary needs
 food labels
 knowledge of food insecurities and how
to access resources (food banks, food
stamps, energy assistance programs)
 physical activity






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inter-professional care and
understanding of the role and
responsibilities of axillaries and allied
health professions
chronic disease management (CHF,
diabetes, heart disease)
maternal-child health
policy development and government
legislative structure
documentation
environmental and basic client
assessment
Use of Community Health Workers
United Kingdom
Dietetic Support Workers usually work under the close supervision of a dietitian in either a
community or hospital setting. A dietetic support worker working in a hospital may, for example,
be involved in assisting patients requiring special diets to choose from the hospital menu,
collecting information regarding patients' intake and weight and liaising with the dietitian
regarding patients' progress. Within a community setting, dietetic support workers may work with
the dietitian to assess the food and health needs of local residents and assist in enabling people to
eat a healthier diet to prevent disease.
Support workers usually start their career with little formal training or experience. They are
required to have a good standard of English and math with excellent communication skills and
qualifications could include relevant General Certificate of Secondary Education, National
Vocational Qualification or Scottish Vocational Qualification. Many have some experience working
in a patient, community or care environment, so for example, in a care home, school or voluntary
organization, catering or in a hospital.
Assistant Practitioners in Dietetics deliver elements of delegated dietetic care. They are usually
educated to Foundation Degree level or equivalent and normally work at a level above dietetic
support workers. However, each role varies depending on the post and also the title used to
describe posts varies.
Canada
Community Support Workers interview, counsel, and assist clients to deal with personal and social
problems. They may also organize and implement a variety of community programs and services.
Individuals in this role may be responsible for preparing intake reports, referring clients to other
social services, admitting clients to appropriate programs, and meeting with clients to evaluate
treatments/plans and progress. The CSW program provides students with the necessary
knowledge and practical skills to provide many types of assistance to people in the community.
Areas of study include addictions, psychology, sociology, mental health, Canadian family dynamic,
professional skills, counselling and interviewing techniques, development, business
communications and report writing.
United States of America
A variety of terms are used to describe the community worker position in the US including
community support worker (CSW), community health worker, and promotoras. There is no set
curriculum at this time for the CSW but various groups such as the American Association of
Diabetes Educators and US Cooperative Extension System have participated in projects to create
curriculum for CSWs. Community Support Worker education program hours range from 20 - 160
hours with practice experiences. The states of Massachusetts, New York, Illinois and Virginia are
seeking state licensure and Maine seeking title protection of Community Health Worker.
Currently ongoing individual credentialing is not required as risk to public is perceived as being
82
low. Many see the potential to see a large increase demand for CSW from insurance companies
due to the Patient Protection and Affordable Healthcare Act.
CHANGES TO RECOMMENDED FUTURE MODEL OF EDUCATION IN NUTRITION AND
DIETETICS
After reviewing results of the data collected, the ACEND Board affirmed its support of the
recommendation for an associate’s degree prepared nutrition and dietetics practitioner who
would provide support in the community setting. The ACEND Board chose to change the name of
the associate’s degree prepared practitioner to the Nutrition Health Worker to make it more
consistent with titles used for community support personnel.
83
ASSESSMENT OF THE 2012 ACEND® ACCREDITATION STANDARDS
By Martha Smith Sharpe
PURPOSE
The purpose of this project was to gather information from various stakeholders to determine
potential changes that might be made to improve on the 2012 ACEND Accreditation Standards for
Programs in Nutrition and Dietetics.
METHODOLOGY
ACEND® contracted with consultant, Martha Smith Sharpe to examine standards set by other
accreditors, review U.S. Department of Education (USDE) requirements and conduct and analyze
results of on online stakeholder survey of the 2012 Standards. The first phase of the project
involved reviewing work previously conducted by ACEND, evaluating the 2012 Standards relative to
requirements for USDE recognition, and assessing the standards’ adequacy in light of common
practices within similar specialized/professional fields’ accrediting standards.
The second phase of the project involved developing an online questionnaire (Appendix G) in
Survey Monkey® that included four major sections: one for collecting demographic information
about respondents, a second to determine participant involvement in doing a Program Assessment
Report (PAR) using the 2012 Standards, a third section that determined participant involvement in
doing a Self-Study/Site Visit using the 2012 Standards and a fourth that involved evaluation of each
of the 23 Standards included in the 2012 Standards. For each standard, respondents were asked to
rate whether the standard was clear and easy to understand and whether providing evidence for
the standard demonstrated program quality using a five-point scale ranging from 1, strongly
disagree to 5, strongly agree. An option of “no opinion” also was included. Respondents were
provide comment boxes with each standard to provide additional comments or concerns.
RESULTS
A total of 407 individuals responded to the survey about the 2012 Standards; most were nutrition
and dietetics program directors (53%) or educators (22%). Nearly 65% of the respondents
indicated having some experience with applying the standards or completing a Program
Assessment Report (PAR) or self-study using the report (Table 11). Respondents indicated the 2012
Standards better prepared them to write a self-study as compared to a PAR.
Respondents were asked to indicate whether the standards were clear and easy to understand and
whether providing evidence for this standards demonstrated quality. As shown in Table 12, there
was variation in perceptions of clarity of individual standards. Nearly all standards had 70% or
more of responses as agree/strongly agree. Standards focused on policies and procedures,
program mission, curriculum length and student complaints had the highest number of
agree/strongly agree responses. Standards focused on program improvement and student learning
assessment had a somewhat lower number of agree/strongly agree responses.
84
Based on a review of the quantitative and qualitative comments, the following recommendations
for changes to future standards documents are offered:

Publish the standards alone in one document with no additional information, but reference to
separate guidance material

Publish a separate document for the guidance material. Differentiate what is the standard
and what is supporting material and use terminology “Suggestions for Narrative” rather than
“Suggested Discussion”

Change from use of Standards and Guidelines to a hierarchical numbering system that retains
the ability to individual standards numbers for each standard.

Use term “evaluation” for the measurement of program objectives and “assessment” for the
measurement of the attainment of student learning outcomes

Give explicit recognition in the Standards to the Core knowledge and Competencies

Combine and streamline the standards
o
o
o
Title Standard 1: Eligibility Standards for Candidate and Accredited Programs

Combine 1.1 and 1.2 – call it Program Sponsorship and Location Within its
Sponsoring Organization

Combine 1.3 and 18 – call it Program Resources

Combine 1.4 and 1.5 – call it Criteria and Types of Program Awards

Combine 1.6 and 12 – call it Curriculum Length and Supervised Practice

Combine 1.7 and 15 – call it Program Director Responsibilities and Credentials

Bring Standard 3 into Standard 1 – call it Programs Established Under
Consortia Agreements

Bring Standard 2 into Standard 1 – leave title same
Title Standard 2: Curriculum

Create a new standard with the information about the knowledge and
competencies from Standard 9 preamble – call it Core Knowledge and
Competencies

Include Standard 9 – Program Concentrations

Include Standard 11 – Learning Activities

Include Standard 10 – Curriculum Mapping
Title Standard 3: Program Planning Evaluation, Assessment, Review and Improvement

Combine Standards 4, 5, 6, and 7 – call it Program Mission, Goals, and
Objectives and Their Evaluation

Include Standard 13 – Student Learning Outcomes and Assessment

Include Standard 14 – Program Review and Improvement
85

o
Title Standard 4: Faculty and Preceptors

o
o
Include parts of Standard 6 – call it Student Achievement Measures
Include Standards 15 and 16
Title Standard 5: Students and the Public

Include Standard 22

Include part of Standard 20 on opportunities to learn, progress and feedback,
soliciting input, verifying remote student identity,

Include Standard 21 - Student Complaints
Title Standard 6: Policies and Procedures

Include Standard 23
86
Table 11. Respondents Experience with Applying the 2012 Standards
n
%
Involved as a program educator or preceptor in activities applying the 2012
Standards
Involved as a program director in completing a self-study/site visit under the
2012 Standards
87
65
21.4%
16.0%
Involved as a program director in completing a PAR under the 2012 Standards
64
15.7%
Involved as an ACEND program reviewer, board member or staff member in
reviewing program PARs and/or self-studies under the 2012 Standards
No involvement in applying the 2012 Standards to a program
40
9.8%
151
37.1%
Type of Experience
Table 12. Respondents Experience in Preparing the Program Assessment Report or Self Study
using the 2012 Standards
a
na
%
The 2012 Standards provided the information the program needed to be well
prepared for writing the PAR
Completing the PAR under the 2012 Standards provided the program the
opportunity to demonstrate the quality of the program
30
50.0%
39
65.0%
Information provided by ACEND regarding the 2012 Standards was easy to
understand and apply in writing the PAR
The 2012 Standards made it clear what was acceptable supporting evidence for
each standard
Preparing the Self-Study
22
36.7%
23
38.3%
The 2012 Standards provided the information the program needed to be well
prepared for writing the self-study report
48
82.8%
The information was easy to understand and apply to writing the self-study
report
34
57.5%
30
51.7%
Experience
Preparing the Program Assessment Report
The 2012 Standards made it clear what was acceptable supporting evidence for
each standard
a
respondents who agreed/strongly agreed with the statement
87
Table 13: Respondents Ratings of Standard Clarity and Demonstration of Quality
Standard Clear
Easy to Interpret
na
%a
na
%a
1: Program Characteristics and Finances
155
81.2%
129
72.1%
2: Title IV Compliance for Free-Standing Programs
87
47.7%
70
39.9%
3: Consortia
84
47.9%
66
38.3%
4: Program Mission
154
90.1%
138
80.6%
5: Program Goals
151
86.7%
145
84.3%
6: Program Objectives
137
81.4%
131
77.9%
7: Program Assessment
135
80.7%
133
79.5%
8: On-going Program Improvement
116
72.0%
113
68.1%
9: Program Concentration
112
69.9%
98
61.5%
10: Curriculum Mapping
124
76.5%
123
76.4%
11: Learning Activities
127
78.8%
124
76.9%
12: Curriculum Length
143
89.9%
122
76.1%
13: Learning Assessment
115
72.3%
112
70.8%
14: On-Going Curricular Improvement
126
79.7%
125
78.5%
15: Responsibilities of Program Director
136
85.5%
123
76.8%
16: Facilities and Preceptors
137
85.5%
128
80.4%
17: Continuing Professional Development
141
88.6%
125
78.1%
18: Program Resources
131
83.6%
118
73.7%
19: Supervised Practice Facilities
118
74.1%
116
72.5%
20: Student Progression and Professionalization
129
81.5%
127
79.3%
21: Student Complaints
142
89.7%
129
81.6%
22: Info Prospective Students and Public
139
88.4%
123
77.3%
23: Policies and Procedures
respondents who agreed/strongly agreed
144
91.1%
136
84.9%
Standard
a
Demonstrates
Program Quality
88
DEVELOPMENT OF
THE FUTURE EDUCATION MODEL
COMPETENCIES AND PERFORMANCE INDICATORS
89
DEVELOPMENT AND VALIDATION OF ENTRY-LEVEL COMPETENCIES AND
PERFORMANCE INDICATORS FOR FUTURE ASSOCIATE, BACHELOR AND
MASTER DEGREE PROGRAMS IN NUTRITION AND DIETETICS
By Leanne Worsfold
PURPOSE
The purpose of this project was to develop, verify and gain consensus on professional and clinical
competencies and performance indicators for future nutrition and dietetics professionals who
graduate, in the year 2025 and beyond, from an associate, bachelors or master’s level program.
METHOD
ACEND® contracted with consultant, Leanne Worsfold, to conduct a multi-round Delphi study to
gather input from a broad base of stakeholders to gain consensus on professional and clinical
competencies for future entry-level nutrition and dietetics professionals. Entry-level
competencies (knowledge, skill and judgment) needed upon graduation from an accredited
nutrition and dietetics education program for early years of practice were identified. These entrylevel competencies could be used to:
 Inform academic curriculum and program syllabi;
 Provide measurable education outcomes for the nutrition and dietetics programs
(associate, bachelor and master level);
 Support competency-based learning by outlining student expectation and defining what
the student should be able to do upon graduation;
 Shape future nutrition and dietetics practice;
 Introduce a new practitioner (associated degree level);
 Increase patient access to nutrition and dietetics health care services;
 Assist in defining nutrition and dietetics job roles and responsibilities;
 Promote legislative changes in scope of practice; and
 Communicate the role of competence nutrition and dietetic practitioners to internal and
external stakeholders (e.g. accreditation bodies and organizations, employers, the public)
The multi-round Delphi study was conducted from spring 2015 through summer 2016 with
national samples of credentialed Registered Dietitian Nutritionists (RDNs) and Nutrition and
Dietetics Technicians, Registered (NDTRs), employers, allied health professionals, educators and
community health workers. The goal of the Delphi process was to systematically facilitate
communication of information via several stages of the consultant asking questions, undertaking
analysis, providing feedback and asking further questions to develop and validate the competency
and performance indicator statements. Information was collected on the draft competencies
using focus groups (in-person and via webinar) and an online questionnaire to reach group
consensus on the final competencies and performance indicators.
90
Throughout each stage of the study, participants were asked to consider the anticipated nutrition
and dietetics practice landscape 10-years or more out, considering: the aging patient population;
emerging healthcare and wellness needs (e.g. mental health, multi and complex health needs,
new diseases, disease prevention) and nutrition trends and issues (e.g. genetically modified foods,
nutrigenomics, behavior modification, changing climate, sustainability, global health);
advancements in technology; anticipated aging health professional populations and lack of human
resources; anticipated workplace needs (e.g. community, health care, business, and rural areas);
and community and global health issues and needs. Each round of the Delphi study focused on
evaluating the list of draft competencies and performance indicators finalized in the previous
round and gaining consensus by the ACEND Standards Committee and Expanded Standards
Workgroup before being presented to the ACEND Board for final review and approval.
Subject Matter Experts
The first step in the competency development process occurred in spring through fall 2015 with a
group of 15 individuals termed subject matter experts (SMEs) that included RDNS and NDTRs from
across the United States who were working or had worked as educators or practitioners in a broad
spectrum of practice areas (inpatient and outpatient clinical nutrition, foodservice management,
school foodservice, business, communication, community nutrition, private practice, public
health, college teaching, research, quality management and healthcare administration).
The SMEs were guided through a multi-step process by consultant Worsfold to determine a
competency framework, develop a competency outline, determine desired complexity of
competency topics for each academic degree and write competencies and performance indicators
for future practitioners prepared at the associate, bachelor and master degree levels.
Desired complexity of the identified competency topics was rated by each SME for each degree
level as 0, Do not include; 1, Broad knowledge, performs with direct supervision or consultation;
2, Deeper comprehension, uses standardized templates, forms and protocols, seeks referral or
guidance when needed or 3, Has extensive knowledge and skill, independently applies critical
thinking and professional judgment. The individual ratings were combined and discussed by the
SME group to finalize a group rating.
The SMEs then developed competency and performance indicator statements for competency
topics included in the outlines for the associate, bachelor and master degree programs in nutrition
and dietetics. Their work was vetted with the ACEND Standards Committee, Expanded Standards
Workgroup, Visioning Group and the ACEND Board at several points during their work.
First Line Review
The second step of the Delphi process was a first line review by a group of educators and
practitioners who participated in online focus groups conducted by consultant Worsfold. A total of
241 individuals were invited to attend one of the 10 focus group sessions to review the draft
competencies and performance indicators and offer suggested changes to content and assigned
academic level. Based on input received, a revised set of competencies and performance
indicators were reviewed by the ACEND Standards Committee, Expanded Standards Workgroup,
91
Visioning Group, Subject Matter Experts, and the ACEND Board before they were shared more
widely for input.
Online Stakeholder Survey
A third step in the process, which involved completion of an online questionnaire (Appendixes HJ), began in April 2016. Random and convenience samples totaling more than 16,000 nutrition
and dietetics practitioners, educators, employers and professionals from outside the field of
nutrition and dietetics (separate samples for each degree level program) were asked to rate the
competencies and the performance indicators. Participants provided ratings on a four-point scale
of perceived importance to future practice in the profession (1, Not important to future practice;
2, Minor importance to future practice; 3, Important for future practice; 4, Critical for future
practice) for each competency and performance indicator and provided a rating on a four-point
scale of the importance to ensuring the public (patient) has access to nutrition and dietetics
services (1, Not important; 2, Minor importance, 3, Important; 4, Critically important) for each
competency. A traditional scale of frequency performed by the profession was not used, given the
competencies were projecting required nutrition and dietetic competence 10 plus-years in the
future. Space for comments was included for each competency and its performance indicators.
Consensus Panel Meeting
In June 2016, a Consensus Panel Meeting was convened, which included the ACEND Standards
and Executive Committee members and the Expanded Standards Workgroup to review the Delphi
study findings and gain consensus on the final competency and performance indicator
statements. Ratings received and comments made about the competencies and performance
indicators in the online survey were reviewed by the group in a week-long consensus panel
meeting. Decisions were made on the wording and inclusion of each competency and
performance indicator based on the input received. The finalized list of competencies and
performance indicators were incorporated into the Future Education Model Accreditation
Standards and were presented to the ACEND Board for their review and approval to be released
for public comment.
RESULTS
In all rounds of the Delphi process, participants and respondents represented a wide variety of
nutrition and dietetics practice settings (clinical care, foodservice, community/public health,
government, education) and roles (clinical care, academic, management, foodservice, community)
from all regions of the United States. Participants held associate, bachelor, master and/or
doctoral degrees and had been in practices from less than three years to more than 20 years.
Practitioners from outside the profession (physicians, nurses, allied health practitioners, business
and industry executives, community health workers) were used as well to provide input into
competencies needed in future nutrition and dietetics practice.
92
Subject Matter Experts Outcomes
The SMEs first conducted a functional analysis of several competency frameworks and
determined a framework that included competencies and performance indicators grouped within
competency units would work best for nutrition and dietetics education (see Figure 3) and
decided to use this framework for their competency development work.
The SMEs generated an initial list of competency units (Table 14) based on an extensive literature
review. Within each competency unit, competency topics were identified. An example of one
competency unit and the initial list of competency topics is shown in Table 15. These competency
topics were discussed by the group and condensed into a smaller number of topics to reduce
overlap and redundancy among topics.
The SMEs completed an exercise wherein they individually rated the desired complexity of each
competency topic for each academic degree level. The individual ratings were combined and
discussed by the SME group to finalize a group rating. An example of group complexity ratings for
one competency unit showing the distinction between the bachelor and master prepared
graduates is provided in Table 16. These group ratings were vetted with the ACEND Standards
Committee, Expanded Standards Workgroup and the ACEND Board before competency
statements and performance indicators were written.
The SME group then worked for several months developing the first draft of the competencies
and performance indicators using the results of the competency complexity ratings and Bloom’s
Cognitive Taxonomy to develop competency statements and indicators of performance mapped
to the academic degree level (associate, bachelor and master). In total the group developed
nearly 100 competency statements and 600 performance indicators (Table 17). An example of
one competency unit (Community and Population Health Nutrition) and the proposed
competency statements within that unit for bachelor and master prepared graduates is shown in
Table 18. Table 19 includes an example of one competency and the performance indicators
developed for that competency.
First Line Review Outcomes
The next round of the competency development Delphi process involved a series of online focus
groups to review the draft standards and competencies and offer suggested changes to wording,
content and assigned academic level. A total of 98 (41% response) individuals participated in one
of the 10 first line review online focus group sessions facilitated by consultant Worsfold.
The first line reviewers offered several changes in verbs used in the competency and performance
indicator statements to better reflect the degree level of the program. Additional competency
statements and performance indicators were suggested for all three degree level programs (Table
20).
Online Survey Outcomes
An online survey was used to gather input on the draft competencies and performance indicators
from a larger group of educators, practitioners and other professionals who work with nutrition
93
and dietetics practitioners; more than 1000 (7% response) responded. Demographic
characteristics of the respondents is found in Table 21.
A total of 242 individuals provided ratings for the associate degree program competencies and
performance indicators, 459 individuals provided ratings for the bachelor degree and 397 provided
ratings for the master degree. The overall mean rating, on a 4-point scale (4-being critical for
future practice), of importance to future practice in the profession for the competency and
performance indicator statements for all three degree levels was 3.41, standard deviation 0.66.
The overall mean rating, on a 4-point scale (4-being critical), of importance to ensuring public
access to nutrition and dietetics services for the competencies and performance indicators for all
three degree levels was 3.27, standard deviation 0.67. Individual ratings on both scales for each
competency are included in Tables 22-24.
Associate degree
The overall mean rating, on a four-point scale (4 being critical for future practice), for importance
to the profession of the associate degree competencies and performance indicators was 3.46,
standard deviation 0.64. The overall mean rating, on a four-point scale (4 being critical), for
importance to public access for the associate degree competencies and performance indicators
was 3.26, standard deviation, 0.68.
As shown in Table 22, all of the competencies for the associate degree were rated higher than 3
on the 4 point scale suggesting that all of the competencies were perceived as being important to
future practice and to the public. The highest rated competencies were “Demonstrates an
understanding of the principles of food and nutrition” (µ=3.83±.39; µ=3.54±.53 respectively) and
“Demonstrates ethical behaviors becoming of the profession” (µ=3.78±.42; µ=3.66±.51
respectively). The lowest rated competency for importance to future practice in the profession
(µ=3.23±.78) and for importance to the public (µ=3.08±.78) was “Advocates for programs and
services for individuals and the community.”
Bachelor degree
The overall mean rating, on a four-point scale (4 being critical for future practice), for importance
to the profession of the bachelor degree competencies and performance indicators was 3.44,
standard deviation 0.67. The overall mean rating, on a four-point scale (4 being critical), for
importance to public access for the bachelor degree competencies and performance indicators
was 3.27, standard deviation 0.68.
As shown in Table 23, nearly all of the competencies for the bachelor degree were rated higher
than 3 on the 4 point scale suggesting that most of the competencies were perceived as being
important to future practice and to the public. The highest rated competencies were in the
professionalism competency unit: “Demonstrates ethical behaviors becoming to the profession”
(µ=3.77±.48) and “Adheres to legislation, regulations and standards of practice” (µ=3.66±.52). The
lowest rated items for importance to future practice in the profession for the bachelor degree
included: “Demonstrates knowledge of math and statistics” (µ=2.98±.69), “Coordinates the
purchasing, receipt and storage of food products and services” (µ=2.98±.76), “Incorporates risk
94
management strategies into practice” (µ=2.94±.77), and “Applies an understanding of agricultural
practices, food technology and processes” (µ=2.92±.73). Ratings of importance to the public also
were less than 3 for these competencies (µ=2.91±.74; µ=2.94±.79; µ=2.90±.80; µ=2.87±.76,
respectively).
Master’s degree
The overall mean rating, on a four-point scale (4 being critical for future practice), for importance
to the profession of the master degree competencies and performance indicators was 3.33,
standard deviation 0.68. The overall mean rating, on a four-point scale (4 being critical), for
importance to public access for the master degree competencies and performance indicators was
3.27, standard deviation 0.66.
As shown in Table 24, nearly all of the competencies for the master degree were rated higher than
3 on the four-point scale suggesting that most of the competencies were perceived as being
important to future practice and to the public. The highest rated competencies were:
“Demonstrates ethical behaviors becoming to the profession” (µ=3.78±.43), “Performs or
coordinates nutritional interventions for all individuals, groups and populations” (µ=3.75±.48) and
“Applies current research and evidence-based practice to services” (µ=3.69±.55). The lowest rated
items for importance to future practice in the profession for the master degree included:
“Develops and implements risk-management strategies and programs” (µ=2.90±.82), “Applies and
demonstrates an understanding of agricultural practices, food technology and processes”
(µ=2.84±.82) and “Oversees the purchasing, receipt and storage of products used in food
production and services” (µ=2.76±.83). Ratings of importance to the public also were less than 3
for these competencies (µ=2.86±.82; µ=2.81±.76; µ=2.79±.78, respectively).
Consensus Panel Outcomes
The consensus panel reviewed ratings for each of the competencies and performance indicators
and all comments made. The group made decisions to modify or delete items as needed.
Associate’s degree
After review of the ratings and the comments, the consensus panel deleted 11 performance
indicators due to noted redundancy or too high in scope of practice and modified nine
performance indicators and one competency to adjust the expected competence level or to
further clarify expectations based on the participants’ comments. Terminology was adjusted
throughout the document to improve consistency in use of terms. As reported in Table 25, the
number of competencies for the associate degree remained unchanged at 20, however, the list of
performance indicators was reduced from 132 to 121.
The panel confirmed, based on the competencies perceived to be important for future practice,
that the associate degree prepared nutrition and dietetics worker would support communitybased nutrition and dietetics services to encourage positive patient and community outcomes.
95
Bachelor’s degree
After review of the ratings and the comments, the consensus panel deleted 24 performance
indicators due to noted redundancy or noted as out-of-scope of practice; and modified 19
performance indicators and two competencies to adjust the expected competence level or to
further clarify expectation based on the participant comments. Terminology was adjusted
throughout the document to improve consistency in use of terms. As reported in Table 25, the
number of competencies for the bachelor degree program remained the same at 38; the list of
performance indicators was reduced from 240 to 216
The panel confirmed that based on perceptions of future practice of the bachelor degree
practitioner the competencies place a focus on autonomous practice in the area of foodservice
management and suggest an expectation for the practitioner to have sufficient nutrition
knowledge to provide direct patient care when patient care needs are well established and
predictable, and work place resources and support (policies, protocols, standardized templates,
registered dietitian nutritionists) are in place.
Master’s degree
After review of the ratings and the comments, the consensus panel deleted 11 performance
indicators due to noted redundancy or noted as out-of-scope of practice; and modified 13
performance indicators and 1 competency to adjust the expected competence level or to further
clarify expectations based on the participant comments. Terminology was adjusted throughout
the document to improve consistency in use of terms. As reported in Table 25, the number of
competencies for the master degree program remained the same at 41; the list of performance
indicators was reduced from 289 to 278.
The panel confirmed that based on perceptions of future practice the master degree level
nutrition and dietetic professional’s competencies places an importance on leadership skills,
research, population and global nutrition and managing highly complex patient care needs.
Recommended Competencies and Performance Indicators
The consensus panel finalized a list of proposed competencies and performance indicators for the
Future Education Model associate, bachelor and master degree programs (Tables 26-28). This list
was then proposed to the ACEND Board by the Standards Committee.
96
Figure 3: Competency framework used for Future Education Model competency development
97
Table 14: Initial competency units developed by subject matter experts
Associate Degree Competency Units
Bachelor and Master Degree Competency Units
Foundation Knowledge
Foundation Knowledge
Professionalism
Client Services
Individual and Community Services
Food Systems Management
Cultural Competence
Community and Population Health Nutrition
Communication, Collaboration and Advocacy
Leadership, Management and Organization
Critical Thinking, Evidence-informed Practice
and Research
Professionalism
Communication, Collaboration and Advocacy
Table 15: Example of a competency unit and competency topics within that unit
Competency Unit
Community and
Population Health
Nutrition
Competency Topics
Population-based data collection
Data synthesis and analysis
Data interpretation
Sustainability
Funding sources
Surveillance of population issues
Population health activities
Nutrition policy
Behavioral health
Food assistance
Development/evaluation of community nutrition programs
Community engagement and partnerships
Government reimbursements/leveraging resources
Disparities in population health
Environmental influences
Corporate wellness
Food availability/resources/ food insecurity
Community advocacy
International nutrition /global health
Government policy/legislation (local, state, federal, international)
98
Table 16: Example of a competency unit, competency topics and complexity rating
Competency Unit
Community and
Population Health
Nutrition
a
Complexity Level
Bachelora
1
Complexity Level
Mastera
2, 3
Principles of health promotion and
population health
1
2, 3
Prevention, wellness and outreach
1, 2
2, 3
Nutrition care process specific to
community and population
1, 2
3
Epidemiology and biostatistics
0
2
Policies, guidelines and standards
1
2, 3
Environmental and system change
0
3
Competency Topics
Public health systems
Scale: 0, Do not include; 1, Broad knowledge, performs with direct supervision or consultation;
2, Deeper comprehension, uses standardized templates, forms and protocols, seeks referral or
guidance when needed or 3, Has extensive knowledge and skill, independently applies critical
thinking and professional judgment
Table 17. Total number of competency units, competency statements and performance indicators
developed by subject matter experts
Degree
Competency Units
Competency Statements
Performance Indicators
Associate
5
20
120
Bachelor
8
35
205
Master
8
38
269
99
Table 18: Example of a competency unit and competency statements for bachelor and master
degree developed by subject matter experts
Unit
Community and
Population Health
Nutrition (Applies
community and
population health
theories to address
nutrition and global
health and wellness)
Bachelor Competencies
1. Assesses, plans, implements
and evaluates communitybased programs.
Master Competencies
1. Assesses, plans,
implements and evaluates
community-, populationand/or global-based
programs to improve the
nutritional health of
vulnerable populations.
2. Identifies community,
population, global
environmental and publichealth hazards, and
participates in and/or
coordinates the
management of the
situation.
3. Engages in legislative and
regulatory activities that
address global nutrition
health and nutrition policy.
100
Table 19: Example of performance indicator statements developed by subject matter experts for
a competency statement for the master degree
Unit: Community and Population Health Nutrition (Applies community and population health
theories to address nutrition and global health and wellness)
Competency: Assesses, plans, implements and evaluates community-, population- and/or globalbased programs to improve the nutritional health of vulnerable populations.
Performance Indicators
1. Demonstrates knowledge of public-health, health-promotion and population-health principles.
2. Recognizes how determinates of health (biological, social, cultural, economic and physical)
influence the health and well-being of a specific population.
3. Conducts and/or facilitates a community- and/or population-based needs assessment.
4. Engages in consultation activities with partners in addressing public-health issues.
5. Identifies and documents epidemiological findings, health disparities, political interests,
impacts of determinates of health, availability of resources, accessibility, and program goals
and objectives.
6. Identifies the resources and partners needed for sustainability of the program.
7. Considers the assessment data and potential strengths, benefits constraints, and limitations
when developing the program.
8. Implements program plan applying project-management skills and adhering to public-health
policies and standards.
9. Collects nutrition surveillance and global health-and-safety data and evaluates the program
using measure indicators and outcomes.
10. Engages in research activities to further nutrition knowledge and population-health practice.
11. Initiates legislative and regulatory activities that address global nutrition health and nutrition
policy.
12. Communicates evaluation findings, outcomes, recommendations and/or research findings to
stakeholders to promote change and substantiate program.
Table 20. Total number of competency units, competency statements and performance indicators
after first line review focus group discussions
Degree
Competency Units
Competency Statements
Performance Indicators
Associate
5
20
132
Bachelor
8
38
240
Master
8
41
289
101
Table 21. Demographic characteristics of respondents to online survey
Associate Degree Bachelor Degree
Characteristics
n
Work Setting
Healthcare (hospital, long term care,
physician network)
76
Educational setting (primary, secondary,
university)
Government (federal, city, state, or local)
public health
Community nonprofit
%
Master Degree
n
%
n
%
22.6%
254
42.1%
210
40.5%
65
19.4%
127
21.0%
118
22.7%
63
18.9%
67
11.1%
46
8.9%
62
18.5%
39
6.5%
23
4.4%
Self-employed, consultant or private practice
22
6.6%
39
6.5%
38
7.3%
Wellness programs (workplace, health clubs,
fitness centers)
20
5.9%
34
5.6%
22
4.2%
Other
27
8.1%
44
7.2%
62
12.0%
Management/Leadership
75
21.2%
108
16.2%
100
17.2%
Clinical care
59
16.7%
215
32.3%
193
33.2%
Community/public health
120
33.9%
107
16.1%
79
13.6%
Foodservice
21
5.6%
68
10.2%
42
7.2%
Academic/Research
47
13.3%
99
14.9%
101
17.4%
Other
32
9.3%
69
10.3%
66
11.4%
Role
Highest Degree Held
Associate’s
19
0.2%
21
5.4%
Master’s
59
93
21.6%
26.6%
41.9%
167
216
36.9%
47.7%
104
217
26.8%
55.9%
Doctorate
22
9.9%
51
15,2%
46
11.9%
3 years or less
22
9.1%
34
7.5%
29
7.3%
4 to 9 years
10 to 20 years
42
60
17.4%
27.0%
83
109
18.2%
23.8%
84
110
21.3%
27.8%
More than 20 years
117
53.5%
231
50.5%
172
43.6%
29
37
12.3%
15.7%
59
47
12.8%
10.2%
53
41
14.0%
10.8%
Region 4 (AZ, CO, KS, NV, NM, OK, TX, UT)
22
65
9.4%
27.7%
75
52
16.3%
11.3%
47
68
12.4%
18.0%
Region 5 (IL, IN, OH, KY, TN, WV)
36
15.3%
75
16.3%
61
16.1%
Region 6 (DE, DC, MD, NC, PA, VA)
17
29
7.2%
12.4%
68
84
14.8%
18.3%
50
58
13.2%
15.5%
Bachelor’s
48
Years of Work Experience
Region of the Country
Region 1 (AK, CA, HI, ID, MT, OR, WA, WY)
Region 2 (IA, MI, MN, MO, NE, ND, SD, WI)
Region 3 (AL, AR, FL, GA, LA, MS, PR, SC)
Region 7 (CT, ME, MA, NH, NJ, NY, RI, VT)
102
Table 22: Ratings of importance for associate degree competencies by participants in an online
survey of the draft competencies
Importance to
Future Practicea
Competencies
n
Mean
Importance to
Publicb
SD
n
Mean
SD
Unit 1. Foundational Knowledge
1.1 Demonstrates an understanding of the principles
of food and nutrition.
242
3.83
.39
237
3.54
.53
1.2 Integrates knowledge of health determinates into
all aspects of care and services.
192
3.54
.56
190
3.44
.63
1.3 Demonstrates knowledge of wellness strategies
that contribute to long-term health.
166
3.55
.60
165
3.38
.60
1.4 Applies principles of food safety and sanitation
standards specific to culinary skills, food supply
and food storage.
163
3.56
.60
163
3.55
.62
1.5 Demonstrates understanding of public health
system.
162
3.25
.72
162
3.28
.70
2.1 Demonstrates ethical behaviors becoming of the
profession.
156
3.78
.42
154
3.66
.51
2.2 Engages in reflective-practice activities to
maintain ongoing competence.
147
3.44
.59
146
3.39
.59
2.3 Adheres to legislation, regulations, standards of
practice and organizational policies.
143
3.68
.51
143
3.56
.58
3.1 Screens basic nutrition and health needs of
individuals and communities.
138
3.55
.57
138
3.50
.61
3.2 Participates in the development, monitoring and
modifications of the client's program.
132
3.41
.64
132
3.39
.60
3.3 Considers the factors that impact food availability
in the community (seasonal, accessibility,
affordability, geographical location) within the
social determinants of health.
131
3.44
.62
131
3.37
.57
3.4 Supports recipe modification and meal planning
based on cultural needs and preferences in
collaboration with other professionals.
124
3.41
.64
124
3.38
.58
3.5 Organizes community nutrition programs and
promotes access to community resources.
122
3.24
.76
121
3.21
.73
Unit 2. Professionalism
Unit 3. Individual and Community Services
3.6 Provides information and pre-developed
117
3.27
.69
117
3.32
.72
evidence-informed educational materials to meet
the needs of the individual and community.
a
Scale: Importance to future practice in the profession: 1, Not important to future practice; 2, Minor
importance to future practice; 3, Important for future practice; 4, Critical for future practice
b
Scale: importance to ensuring the public (patient) has access to nutrition and dietetics services: 1, Not
important; 2, Minor importance, 3, Important; 4, Critically important
103
Table 22: cont.
Importance to
Future Practicea
Competencies
n
Mean
Importance to
Publicb
SD
n
Mean
SD
Unit 4. Cultural Competence
4.1 Demonstrates an understanding of the principles
of cultural competence.
115
3.50
.63
115
3.43
.69
4.2 Identifies and addresses cultural needs of the
individual and community.
113
3.39
.74
113
3.35
.69
4.3 Demonstrates knowledge of foods, cultural and
religious food traditions, eating patterns and
trends in the community.
113
3.50
.57
113
3.42
.62
5.1 Applies effective written and oral communication
skills and techniques to achieve desired goals and
outcomes.
112
3.69
.49
112
3.63
.48
5.2 Works collaboratively with intra- and interprofessional team members, individuals and the
community.
112
3.63
.52
112
3.47
5.7
5.3 Advocates for programs and services for
individuals and the community.
112
3.23
.78
112
3.08
.78
Unit 5. Communication, Collaboration and Advocacy
104
Table 23: Ratings of importance for bachelor degree competencies by participants in an online
survey of the draft competencies
Importance to
Future Practicea
Competencies
n
Mean
Importance to
Publicb
SD
n
Mean
SD
Unit 1. Foundational Knowledge
1.1 Applies a basic understanding of environmental
and genetic factors in the development and
management of disease.
459
3.36
.63
457
3.48
.55
1.2 Demonstrates an understanding of anatomy and
physiology.
404
3.49
.59
404
3.44
.60
1.3 Demonstrates an understanding of microbiology
and food safety.
374
3.41
.57
374
3.51
.56
1.4 Demonstrates knowledge of chemistry and food
science as it pertains to food and nutrition.
358
3.14
.64
358
3.10
.68
1.5 Demonstrates and applies knowledge of pathophysiology and biochemical functionality and
their relationship to physiology (health and
disease).
339
3.47
.66
338
3.55
.58
1.6 Applies knowledge of social, psychological and
environmental aspects of eating and food.
315
3.45
.58
315
3.36
.63
1.7 Applies the principles of cultural competence
within own practice.
306
3.39
.62
305
3.33
.69
1.8 Demonstrates basic knowledge of nutrition
pharmacology, and integrative and functional
therapy.
296
3.39
.63
296
3.32
.61
1.9 Demonstrates knowledge of math and statistics.
289
2.98
.69
289
2.91
.74
1.10 Demonstrates knowledge of medical
terminology when communicating with
individuals.
286
3.59
.56
286
3.44
.64
1.11 Demonstrates knowledge of food preparation
and techniques.
282
3.22
.67
292
3.16
.67
1.12 Applies technology in the decision-making
process.
273
3.26
.72
273
3.30
.62
1.13 Applies nutrition knowledge in the provision of
nutrition care at all stages of the life cycle.
265
3.61
.55
265
3.52
.55
1.14 Applies knowledge of health promotion and
prevention for individuals and groups.
256
3.52
.58
256
3.40
.61
a
Scale: Importance to future practice in the profession: 1, Not important to future practice; 2, Minor
importance to future practice; 3, Important for future practice; 4, Critical for future practice
b
Scale: importance to ensuring the public (patient) has access to nutrition and dietetics services: 1, Not
important; 2, Minor importance, 3, Important; 4, Critically important
105
Table 23: cont.
Importance to
Future Practicea
Competencies
n
Mean
Importance to
Publicb
SD
n
Mean
SD
Unit 2. Client Services
2.1 Applies a framework to assess, develop,
implement and evaluate program and services.
239
3.21
.66
239
3.00
.75
2.2 Conducts and interprets nutritional status
screening for individuals, groups or targeted
population using standardized tools.
230
3.58
.57
230
3.43
.62
2.3 Utilizes the nutrition care process to manage
clients/patient s with less complex health needs
in a supportive health system.
226
3.40
.71
226
3.45
.66
2.4 Performs nutritional interventions for clients with
less complex care needs when environmental
supports are in place.
211
3.39
.67
211
3.46
.61
2.5 Considers the patient's use of, and beliefs and
values related to nutrition integrative and
functional therapy.
199
3.38
.60
199
3.27
.63
3.1 Manages the production, distribution, and service
of quantity and quality of food products.
193
3.18
.71
193
3.17
.68
3.2 Coordinates the purchasing, receipt and storage
of food products and services.
190
2.98
.76
190
2.94
.79
3.3 Applies principles of food safety and sanitation to
the production and service of food.
188
3.44
.70
188
3.29
.72
3.4 Applies an understanding of agricultural
practices, food technology and processes.
187
2.92
.73
187
2.87
.76
187
3.11
.73
187
3.05
.73
5.1 Demonstrates leadership skill to guide practice.
186
3.42
.66
186
3.40
.64
5.2 Applies principles of organization management.
186
3.14
.77
186
2.99
.79
5.3 Applies project management principles to achieve
project goals and objectives.
183
3.08
.74
182
3.04
.77
5.4 Incorporates quality improvement into practice.
182
3.13
.72
182
3.04
.77
5.5 Incorporates risk management strategies into
practice.
182
2.94
.77
182
2.90
.80
Unit 3. Food Systems Management
Unit 4. Community and Population Health Nutrition
4.1 Assesses, implements and evaluates community
and population-based programs.
Unit 5. Leadership, Management and Organization
106
Table 23. cont.
Importance to
Future Practicea
Competencies
n
Mean
Importance to
Publicb
SD
n
Mean
SD
Unit 6. Critical Thinking, Evidence-informed Practice and Research
6.1 Incorporates critical thinking skills in overall
practice.
181
3.55
.60
181
3.38
.73
6.2 Identifies and understands the scientific method
and research ethics.
180
3.26
.69
180
3.07
.78
6.3 Applies current research and evidence-based
practice to services.
179
3.49
.62
179
3.39
.72
7.1 Demonstrates ethical behaviors becoming to the
profession.
179
3.77
.48
179
3.68
.56
7.2 Engages in self- reflective practice activities to
maintain ongoing competence and professional
behaviors.
178
3.47
.65
178
3.29
.65
7.3 Adheres to legislation, regulations and standards
of practice.
178
3.66
.52
178
3.63
.57
8.1 Applies effective communication skills and
techniques to achieve desired goals and
outcomes.
178
3.62
.52
178
3.54
.57
8.2 Works with and facilitates intra- and interprofessional collaboration and teamwork.
178
3.39
.65
178
3.25
.69
8.3 Demonstrates advocacy skills to promote
awareness and required change.
178
3.24
.67
178
3.15
.75
Unit 7. Professionalism
Unit 8: Communication, Collaboration and Advocacy
107
Table 24: Ratings of importance for master degree competencies by participants in an online
survey of the draft competencies
Importance to
Future Practicea
Competencies
n
Mean
Importance to
Publicb
SD
n
Mean
SD
Unit 1. Foundational Knowledge
1.1. Applies an understanding of environmental and
genetic factors in the development and
management of disease.
397
3.35
.64
388
3.43
.57
1.2. Applies an understanding of anatomy and
physiology.
344
3.59
.57
342
3.60
.54
1.3. Applies knowledge of microbiology and food
safety.
311
3.38
.58
311
3.36
.64
1.4. Integrates knowledge of chemistry and food
science as it pertains to food and nutrition,
product development and when making
modifications to food.
289
3.10
.70
287
2.98
.71
1.5. Demonstrates and applies knowledge of pathophysiology and biochemical functionality and
their relationship to physiology (health and
disease).
263
3.57
.60
263
3.57
.55
1.6. Applies knowledge of social, psychological and
environmental aspects of eating and food.
248
3.46
.62
247
3.30
.60
1.7. Integrates the principles of cultural competence
within own practice and when directing services.
232
3.39
.67
230
2.36
.64
1.8. Applies knowledge of pharmacology, and
integrative and functional therapy to recommend,
prescribe and administer nutrition related
therapy.
222
3.44
.68
223
3.40
.57
1.9. Applies knowledge of math and statistics.
217
2.95
.76
217
2.68
.80
1.10. Applies knowledge of medical terminology
when communicating with individuals, groups and
other health professionals.
214
3.71
.49
214
3.53
.56
1.11. Demonstrates knowledge of food preparation
and techniques.
208
3.25
.73
208
3.13
.74
1.12. Applies technology in the decision-making
process.
203
3.37
.67
203
3.28
.65
1.13. Integrates knowledge of nutrition and physical
activity in the provision of nutrition care at all
stages of the life cycle.
197
3.59
.52
197
3.48
.54
a
Scale: Importance to future practice in the profession: 1, Not important to future practice; 2, Minor
importance to future practice; 3, Important for future practice; 4, Critical for future practice
b
Scale: importance to ensuring the public (patient) has access to nutrition and dietetics services: 1, Not
important; 2, Minor importance, 3, Important; 4, Critically important
108
Table 24. cont.
Importance to
Future Practicea
Competencies
n
Mean
Importance to
Publicb
SD
n
Mean
SD
Unit 1. Cont.
1.14. Applies knowledge of health promotion and
prevention for individuals, groups and
populations.
194
3.52
.59
194
3.44
.59
1.15. Gains a foundational knowledge on global
health issues and nutritional needs.
192
2.95
.68
191
2.86
.67
2.1. Creates a framework to assess, develop,
implement and evaluate products, programs or
services.
177
3.07
.72
176
2.94
.72
2.2. Selects, develops or implements nutritional
status screening tools for individuals, groups or
populations.
174
3.41
.61
174
3.35
.57
2.3. Utilizes the nutrition-care process with
individuals, groups or population to manage
complex health needs and comprehensive
systems in all practice settings.
168
3.60
.58
168
3.58
.56
2.4. Performs or coordinates nutritional interventions
for all individuals, groups and populations.
150
3.63
.51
150
3.58
.51
2.5. Prescribes or recommends nutrition-related
drugs, supplements, nutrition integrative and
functional therapy.
146
3.36
.75
146
3.45
.69
3.1. Oversees the production and distribution of
quantity and quality food products.
143
3.01
.74
143
2.97
.72
3.2. Oversees the purchasing, receipt and storage of
products used in food production and services
142
2.76
.83
142
2.79
.78
3.3. Applies principles of food safety and sanitation
to the production and service of food.
140
3.21
.80
140
3.10
.72
3.4. Applies and demonstrates an understanding of
agricultural practices, food technology and
processes.
140
2.84
.82
140
2.81
.76
Unit 2. Client Services
Unit 3. Food Systems Management
109
Table 24. cont.
Importance to
Future Practicea
Competencies
n
Mean
Importance to
Publicb
SD
n
Mean
SD
Unit 4. Community and Population Health Nutrition
4.1. Assesses, plans, develops, implements and
evaluates community, population and global
programs to improve the nutritional health of
vulnerable populations.
137
3.15
.77
137
3.04
.71
4.2. Identifies community, population, global,
environmental and public health hazards, and
participates in or coordinates the management of
the situation.
136
2.91
.78
136
3.01
.73
4.3. Engages in legislative and regulatory activities
that address community, population and global
nutrition health and nutrition policy.
136
2.91
.77
136
2.82
.73
5.1. Demonstrates leadership skill to guide practice.
135
3.53
.66
135
3.47
.69
5.2. Applies principles of organization management.
135
3.19
.74
135
3.06
.75
5.3. Applies project management principles to
achieve the project goals and objectives.
134
3.15
.74
134
3.00
.77
5.4. Leads quality improvement activities to measure,
evaluate and improve a program, services,
products and initiatives.
134
3.25
.73
134
3.10
.75
5.5. Develops and implements risk-management
strategies and programs.
134
2.90
.82
134
2.86
.82
6.1. Incorporates critical thinking skills in managing
more complex situations.
134
3.55
.63
134
3.43
.70
6.2. Applies scientific methods utilizing ethical
research practices, when reviewing, evaluating
and conducting research.
133
3.44
.67
133
3.30
.70
6.3. Applies current research and evidence-based
practice to services.
132
3.69
.55
132
3.58
.58
7.1. Demonstrates ethical behaviors becoming to the
profession.
132
3.78
.43
132
3.67
.53
7.2. Engages in self-reflective practice activities to
develop and demonstrate social and emotional
intelligence to maintain ongoing competence and
professional behaviors.
131
3.40
.71
131
3.39
.64
7.3. Adheres to and advocates for legislation,
regulations and standards of practice.
131
3.49
.71
131
3.52
.63
Unit 5. Leadership, Management and Organization
Unit 6. Critical Thinking, Evidence-informed Practice and Research
Unit 7. Professionalism
110
Table 24: cont.
Importance to
Future Practicea
Competencies
n
Mean
Importance to
Publicb
SD
n
Mean
SD
Unit 8: Communication, Collaboration and Advocacy
8.1. Applies effective communication skills and
techniques to achieve desired goals and
outcomes.
131
3.63
.54
131
3.55
.62
8.2. Works with and facilitates intra- and interprofessional collaboration and teamwork.
131
3.52
.57
131
3.35
.61
8.3. Demonstrates advocacy skills to promote
awareness and required change.
131
3.25
.67
131
3.17
.71
Table 25. Total number of competency units, competency statements and performance indicators
finalized by the consensus panel
Degree
Competency Units
Competency Statements
Performance Indicators
Associate
5
20
121
Bachelor
8
38
216
Master
8
41
278
111
Table 26. Proposed competencies and performance indicators for future associate degree programs
Unit 1 Foundational Knowledge
Applies foundational food and nutrition knowledge to ensure safe, competent and effective services.
Competencies
Performance Indicators
1.1
Demonstrates an
understanding of the
principles of food
and nutrition.
1.1.1 Considers the impact of food and nutrition on wellness, health promotion
and disease throughout stages of the life cycle.
1.1.2 Incorporates basic knowledge of food and nutrition requirements to
provide appropriate services throughout stages of the life cycle and across
disease states.
1.1.3 Identifies, assesses and manages potential primary nutritional risks that
may impact the delivery of safe and effective foodservices.
1.1.4 Investigates and suggests improvements to basic nutritional risk
management plans.
1.1.5 Modifies recipes for acceptability and affordability to accommodate
cultural diversity and health status in less complex situations and health
conditions.
1.1.6 Applies knowledge of food insecurity in the provision of community
health services.
1.2
Integrates
knowledge of
determinants of
health into all
aspects of nutrition
care and services.
1.2.1 Explains to stakeholders how demographic, social and economic factors
and ecological issues affect the individual, group and community wellbeing.
1.3
1.3.1 Supports the development and modifications of wellness, exercise and
nutrition programs to meet the nutrition needs of the client/patient,
community and organization.
Demonstrates
knowledge of
wellness strategies
that contribute to
long term health.
1.2.2 Takes into consideration demographics, lifestyle risk factors and
socioeconomic factors to manage food and nutrition needs.
1.2.3 Identifies key environmental factors that affect services and access to
food.
1.3.2 Implements wellness activities for various audiences, utilizing agencyapproved materials.
1.3.3 Promotes nutritional well-being and assists with self-management for the
prevention of non-communicable diseases to the community.
1.3.4 Summarizes how society, media, culture, social norms and peer pressures
influence wellness.
1.3.5 Defines dimensions of wellness.
1.3.6 Obtains and interprets information relating to the determinants of health.
1.4
Applies principles of
food safety and
sanitation standards
specific to culinary
skills, food supply
and food storage
1.4.1 Follows food safety and sanitation regulations, policies and procedures.
1.4.2 Educates others on food safety principles.
112
Table 26. cont.
Unit 1 cont.
Competencies
Performance Indicators
1.5
1.5.1 Identifies appropriate services and refers clients to public health and
health care systems.
Demonstrates
understanding of
public health system.
1.5.2 Promotes nutrition programs and resources within the community.
Unit 2: Professionalism
Assumes professional responsibilities to provide safe, ethical and effective nutrition services.
2.1
Demonstrates
ethical behaviors
becoming of a
professional.
2.1.1 Refers individuals for consultation when issues are beyond scope of
practice.
2.1.2 Takes accountability for actions and decisions.
2.1.3 Demonstrates honesty and integrity through trustworthy, transparent,
respectful and non-judgmental behaviors.
2.1.4 Practices in a manner that respects diversity and avoids prejudicial
treatment of an individual, group or the community.
2.1.5 Applies client-centered principles to all activities and services.
2.1.6 Understands the dynamics of the provider-client/patient relationship.
2.1.7 Recognizes, maintains and balances professional boundaries with
clients/patients.
2.1.8 Recognizes and manages ethical dilemmas.
2.1.9 Analyzes the impact of one’s own professional behaviors, values, beliefs
and actions on others.
2.1.10 Applies principles of the informed consent process prior to engaging a
client in services.
2.2
Engages in reflective
practice activities to
maintain ongoing
competence and
self-awareness.
2.2.1 Demonstrates continuous self-awareness by critically evaluating one’s
own knowledge, skill and judgment to determine the appropriateness of
performing the activity and providing the service.
2.2.2 Self-reflects on own experiences and personal opinions.
2.2.3 Self-reflects on own position and relationships in the community and how
this impacts the services provided.
2.2.4 Obtains feedback and demonstrates a willingness to consider opinions of
others.
2.2.5 Identifies and reviews evidence-informed literature and credible health
information sources.
2.2.6 Demonstrates critical thinking to inform decisions and actions.
2.2.7 Reflects on and incorporates own experiences and learning in practice
and determines the appropriateness of the situation before proceeding.
2.2.8 Develops own learning goals and objectives and identifies activities to
meet goals.
2.2.9 Maintains current knowledge of evidence-informed nutrition and
dietetics information.
113
Table 26. cont.
Unit 2 cont.
Competencies
Performance Indicators
2.3
Adheres to
legislation,
regulations,
standards of practice
and organizational
policies.
2.3.1 Understands governance of nutrition and dietetics practice such as the
legislative scope of nutrition and dietetics practice and the Code of Ethics
for the nutrition and dietetics profession.
2.3.2 Adheres to confidentiality and privacy legislation, practice standards and
organization’s policies.
2.3.3 Demonstrates awareness of all mandatory reporting obligations.
2.3.4 Protects the confidentiality and security of information throughout
collection, storage, use, dissemination and destruction process.
2.3.5 Works within the defined role and responsibilities outlined by the
employer.
Unit 3: Individual and Community Services
Applies and integrates client-centered principles supporting access to services, and promotes health
and wellness of an individual and community.
3.1
Screens basic
nutrition and health
needs of individuals
and communities.
3.1.1 Uses standardized nutrition screening tools to identify client/patient’s
and community’s nutritional risks and needs.
3.1.2 Adheres to guidelines, protocols and policies when performing nutrition
screening.
3.1.3 Collects data using interviewing skills, observation and available evidence
to inform nutrition screening process.
3.1.4 Collects relevant information about the client/patient’s prior function,
abilities, nutritional health and environment.
3.1.5 Identifies internal and external environmental factors that may impact
the client/patient’s or community’s nutrition health outcomes.
3.1.6 Identifies and accesses resources that may enhance the nutritional health
and wellness of the client/patient and community.
3.1.7 Reports findings to support the development of the nutrition plan and to
inform client/patient or community nutrition needs.
3.1.8 Recognizes client/patient’s nutritional health status, symptoms and
abilities and refers to others when appropriate.
3.1.9 Determines factors that may influence nutrition intake and nutritional
status.
3.1.10 Recognizes nutritional health behaviors and determinants of health
attributes that influence food habits and preferences in individuals,
groups and communities.
3.2
Participates in the
development,
monitoring and
modifications of the
client/patient’s
nutrition programs.
3.2.1 Reports nutrition screening data to inform the development of the
nutrition plan of care.
3.2.2 Accurately communicates client/patient’s nutritional health status,
symptoms and abilities and facilitates appropriate referrals.
3.2.3 Communicates cultural and personal nutrition needs of the client/patient
and community to appropriate team members.
114
Table 26. cont.
Unit 3 cont.
Competencies
Performance Indicators
3.2 cont.
3.2.4 Supports the client/patient’s understanding of the nutrition plan of care
in his or her cultural context.
3.2.5 Implements the established nutrition program and plan of care in
collaboration with the client/patient and other team members.
3.2.6 Monitors and reports a client/patient’s nutritional health status following
established protocols and procedures.
3.2.7 Reports changes in nutritional health status, situation, environment and
or compliance to appropriate team member.
3.3
Considers the factors
that impact food
availability in the
community within
the social
determinants of
health.
3.4
Supports recipe
modification and
meal planning based
on cultural needs
and preferences in
collaboration with
other professionals.
3.5
Coordinates
community nutrition
programs and
promotes access to
community
resources.
3.3.1 Uses standardized nutrition educational material templates, forms and
protocols in menu planning.
3.3.2 Demonstrates basic meal preparation skills applying culinary skills and
knowledge of healthy food choices and disease management.
3.3.3 Reviews a client/patient’s menus considering the nutrition and health
needs based on established criteria and nutrition plan of care.
3.3.4 Considers the factors that impact food availability in the community.
3.3.5 Considers client/patient needs, nutritional requirements, and aesthetic
characteristics of foods, following established guidelines.
3.4.1 Provides nutrition education using approved materials and protocols for
meal planning, recipes, understanding food labels and purchasing.
3.4.2 Applies knowledge of basic food science and food preparation techniques.
3.4.3 Reviews meal plans and recipes and makes recommendations for changes
based on established criteria.
3.4.4 Promotes healthful food choices and healthful eating behavior.
3.5.1 Identifies and explains individual, public, private, organizational and
government roles and responsibilities.
3.5.2 Maintains current knowledge of community resources available to
clients/individuals and the community.
3.5.3 Contributes to a community needs assessment and supports
implementation of services.
3.5.4 Engages in stakeholder consultation to support the development and
implementation of a program, service and resource.
3.5.5 Takes into consideration sustainability and population disparities when
planning for the program, service and resources.
3.5.6 Contributes to the design of the nutrition program, service and resources
considering the determinants of health.
3.5.7 Obtains community and organizational support for the implementation of
the program, service and resource.
3.5.8 Evaluates services and resources using agency-approved evaluation
criteria, tools and methods.
115
Table 26. cont.
Unit 3 cont.
Competencies
Performance Indicators
3.6
3.6.1 Determines the needs of the client/patient or group considering the
determinants of health culture and the readiness for change.
Provides nutrition
information and
approved evidenceinformed nutrition
educational
materials to meet
the needs of the
individual and
community.
3.6.2 Selects appropriate evidence-informed materials to meet the needs of the
audience.
3.6.3 Selects the appropriate delivery method to meet the needs of the
audience and overall nutrition goals.
3.6.4 Suggests modifications to the materials to ensure cultural acceptance.
3.6.5 Evaluates the effectiveness of the nutrition information and education.
Unit 4: Cultural Competence
Applies cultural principles to guide services and to positively impact nutrition and health behaviors of
individuals and the community.
4.1
4.1.1 Develops an awareness of how cultural differences influence interactions.
Demonstrates an
understanding of the
principles of cultural
competence.
4.1.2 Gains a holistic understanding of the client/patient’s and community’s
needs considering the determinants of health.
4.1.3 Develops self-awareness of personal beliefs, values and biases to better
serve clients/patients from different cultures and backgrounds.
4.1.4 Respects the human rights of clients/patients and the community.
4.1.5 Empowers clients/patients to value cultural identity and well-being.
4.1.6 Takes into consideration the culture of the work setting and the different
cultures of the team members.
4.2
Identifies and
addresses cultural
needs of the
individual and
community.
4.2.1 Identifies and addresses barriers to implementing culturally competent
practices.
4.2.2 Identifies strategies for dealing respectfully with clients/patients whose
cultural background or language is different from one’s own.
4.2.3 Recognizes the importance of social and cultural norms, community
wishes and challenges with integration into the community.
4.2.4 Modifies services to meet the needs of culturally diverse clients/patients
and groups.
4.2.5 Promotes delivery of culturally sensitive nutrition care and resources.
4.3
4.3.1 Identifies client/patient’s and group’s cultural food and eating patterns.
Demonstrates
knowledge of foods,
cultural and religious
food traditions,
eating patterns and
trends in the
community.
4.3.2 Recognizes cultural diversity in food preparation and traditions.
4.3.3 Integrates knowledge of cultural foods when practicing culinary skills and
when selecting and providing nutrition educational materials.
116
Table 26. cont.
Unit 5: Communication, Collaboration and Advocacy
Applies effective communication techniques to achieve common nutrition health goals.
Competencies
Performance Indicators
5.1
5.1.1 Fosters open, honest, clear and ethical communication.
Applies effective
written and oral
communication skills
and techniques to
achieve desired goals
and outcomes.
5.1.2 Communicates clearly and effectively.
5.1.3 Selects appropriate mode of communication for specific messaging to
meet the needs of the audience.
5.1.4 Identifies and addresses barriers to communication.
5.1.5 Adapts communication style to meet diverse needs of clients/patients
and groups.
5.1.6 Uses effective verbal and written communication skills to deliver
information in a respectful thoughtful manner.
5.1.7 Writes clearly, concisely and professionally using correct spelling and
grammar.
5.1.8 Uses active listening techniques.
5.1.9 Offers communications in the preferred language of the client/patient
and seeks support from a professional interpreter when needed.
5.1.10 Interprets and responds to nonverbal communications.
5.1.11 Utilizes technology competently, ethically and efficiently to support
delivery of services.
5.1.12 Documents all client/patient encounters following the standards of the
profession and organizational policies.
5.1.13 Confirms information is credible and evidence-informed prior to
communications
5.2
5.2.1 Communicates role and responsibilities accurately to others.
Works collaboratively
with
intraprofessional and
interprofessional
team members,
individuals and the
community.
5.2.2 Applies networking skills to establish opportunities and to support
clients/patients and community services.
5.2.3 Respects the opinions and values of others.
5.2.4 Seeks consultation and refers to other professionals when needed.
5.2.5 Demonstrates conflict management skills.
5.2.6 Understands meeting management principles in order to effectively
participate in meetings and small group activities.
5.2.7 Collaborates with community partners and stakeholders in promoting
individual, group and community nutritional health.
5.2.8 Consults with others and provides nutrition information within the
community using agency-approved nutrition education materials.
5.3
5.3.1 Defines and compares various types of community advocacy.
Advocates for
nutrition programs
and services for
individuals and the
community.
5.3.2 Participates in activities of an advocacy-based organization.
5.3.3 Networks with internal and community professional groups and
organizations.
5.3.4 Identifies and suggests strategies for reaching individuals in populations
that do not access available resources in the community.
117
Table 27. Proposed competencies and performance indicators for future bachelor degree programs
Unit 1: Foundational Knowledge
Applies foundational sciences to food and nutrition knowledge to meet the needs of individuals,
groups, and organizations.
Competencies
Performance Indicators
1.1
1.1.1 Identifies and considers environmental and genetic factors that influence
the development of disease.
Applies a basic
understanding of
environmental and
genetic factors and
food in the
development and
management of
disease.
1.2
Demonstrates an
understanding of
anatomy and
physiology.
1.3
Demonstrates an
understanding of
microbiology related
to food and nutrition
and food safety.
1.1.2 Identifies and considers the influence of food consumption on the
development of disease.
1.1.3 Identifies the foods needed to treat acute and chronic diseases.
1.2.1 Recognizes anatomical structures and explains the physiological functions
of the body.
1.2.2 Describes the physiological processes of humans.
1.2.3 Analyzes the impact of disease state, injury and food on different body
systems and functions.
1.3.1 Applies food safety principles across all stages of the life cycle and all
stages during the flow of food.
1.4
Demonstrates
knowledge of
chemistry and food
science as it pertains
to food and
nutrition.
1.4.1 Applies fundamental chemistry and organic chemistry principles to
enhance understanding of food.
1.5
1.5.1 Explains ingestion, digestion, absorption, metabolism and excretion of
nutrients.
Demonstrates and
applies knowledge of
patho-physiology
and biochemical
functionality and
their relationship to
physiology.
1.4.2 Applies nutritional biochemistry principles to the understanding of human
nutrition health and metabolism.
1.4.3 Explains the chemical nature of food and the impact on food quality,
acceptability and compatibility.
1.5.2 Recognizes nutritional biochemical indicators specific to the disease
process.
1.5.3 Explains the effect of diet, fluids, electrolytes and nutritional status on the
development and progress of the disease process.
1.5.4 Explains the effects of disease, clinical conditions and treatment on
nutritional health status.
118
Table 27. cont.
Unit 1: Foundational Knowledge (cont.)
Competencies
Performance Indicators
1.6
1.6.1 Identifies social and psychological factors affecting intake of food and
impacting nutritional status.
Applies knowledge
of social,
psychological and
environmental
aspects of eating and
food.
1.6.2 Demonstrates an understanding of behavioral health as an overall
component of health, wellness and nutritional status.
1.6.3 Defines and discusses the practice of sustainability, food and water waste,
reusable/biodegradable items, local produce sourcing and access to food.
1.6.4 Identifies key environmental factors that may affect services and/or
access to food.
1.7
1.7.1 Demonstrates knowledge of the cultural competence models.
Applies the
principles of cultural
competence within
own practice.
1.7.2 Applies knowledge of foods, cultural foods, eating patterns and food
trends.
1.7.3 Identifies challenges that arise when different cultures, values, beliefs and
experiences exist between clients/patients and nutrition and dietetics
professionals.
1.7.4 Identifies and implements strategies to address cultural biases and
differences.
1.7.5 Applies culturally sensitive approaches and communication skills.
1.7.6 Develops self-awareness of one’s own personal beliefs, values and biases
to better serve clients/patients of different cultures and backgrounds.
1.8
Demonstrates basic
knowledge of
pharmacology and
integrative and
functional nutrition.
1.8.1 Identifies the major pharmacological classifications to inform potential
drug and food interactions.
1.8.2 Recognizes significant drug and nutrient interactions to inform practice
and ensure client/patient safety.
1.8.3 Identifies evidence-based literature and resources related to
pharmacology and integrative and functional nutrition.
1.8.4 Identifies the purpose, risks, disadvantages and contraindications of
commonly used therapies.
1.9
1.9.1 Understands fundamental statistics concepts and basic application.
Demonstrates
knowledge of math
and statistics.
1.9.2 Demonstrates understanding and applies mathematical concepts and
problem solving in nutrition and food-related activities.
1.10
1.10.1 Communicates with health care professionals using basic medical
terminology.
Demonstrates
knowledge of
medical terminology
when
communicating with
individuals.
1.10.2 Uses acceptable medical abbreviations and appropriate medical
terminology in oral and written communications.
1.10.3 Demonstrates understanding of common terms used by other disciplines.
119
Table 27. cont.
Unit 1: Foundational Knowledge (cont.)
Competencies
Performance Indicators
1.11
1.11.1 Applies appropriate cooking skills and techniques.
Demonstrates
knowledge of food
preparation
techniques.
1.11.2 Converts recipes and ingredients based on client/patient preferences or
dietary needs.
1.11.3 Properly operates equipment and common culinary hand tools.
1.11.4 Complies with and practices safe work habits, identifies safety hazards
and employs preventive safety measures.
1.11.5 Applies consistent portion control skills.
1.11.6 Reads and follows recipes.
1.11.7 Ensures foods are aesthetically pleasing, appealing and tasteful.
1.12
1.12.1 Applies technology in the decision making process.
Applies nutrition
informatics in the
decision making
process.
1.12.2 Describes factors to consider when accessing and evaluating nutritional
health information online.
1.12.3 Identifies trends in nutritional health care and food systems.
1.12.4 Uses electronic databases to obtain information.
1.12.5 Proficiently uses new technology to enhance practice and client/patient
care.
1.13
Applies nutrition
knowledge in the
provision of nutrition
care at all stages of
the life cycle.
1.14
Applies knowledge
of nutritional health
promotion and
disease prevention
for individuals and
groups.
1.13.1 Compares and contrasts nutrition needs of individuals at all stages of the
life cycle using standardized templates and guidelines.
1.13.2 Calculates nutritional needs of individuals based on comparative
standards.
1.14.1 Determines impact of physical activity and movement on nutritional
needs.
1.14.2 Compares the relationship between the determinants of health and
dimensions of wellness.
1.14.3 Applies knowledge of epidemiology related to dimensions of wellness
and disease prevention.
1.14.4 Recognizes the cause of disease and threats to the health of individuals
and groups.
1.14.5 Identifies risk reduction strategies for individuals and groups.
1.14.6 Keeps current about media, culture and peer influences on dimensions of
wellness.
1.14.7 Identifies effects of deficiencies and toxicities of nutrients on nutritional
health.
1.14.8 Applies behavior change theories for nutritional health promotion and
disease prevention.
120
Table 27. cont.
Unit 2: Client/Patient Services
Applies and integrates client/patient-centered principles and competent nutrition and dietetics
practice to ensure positive outcomes.
Competencies
Performance Indicators
2.1
2.1.1 Conducts an assessment of the practice setting environment, competitive
landscape and stakeholder opinions to identify and evaluate data needed
to make decisions regarding nutritional products, programs and services.
Applies a framework
to assess, develop,
implement and
evaluate nutritional
program and
services directed to
clients/patients
whose nutritional
health needs are less
complex.
2.2
Conducts and
interprets nutrition
screening using
standardized tools
for individuals,
groups or targeted
populations whose
nutritional health
needs are less
complex.
2.3
Utilizes the nutrition
care process to
manage
clients/patients with
less complex
nutritional health
needs when practice
setting
environmental
supports are in
place.
2.1.2 Identifies opportunities for nutritional intervention/improvement.
2.1.3 Implements programs or services following predefined designs, plans or
models.
2.1.4 Evaluates effectiveness of nutritional programs, products or services by
analyzing reasons for variance from expected outcomes and implements
new strategies, as appropriate.
2.1.5 Collaborates with appropriate stakeholders.
2.2.1 Selects nutrition and activity screening tools taking into consideration all
client/patient factors.
2.2.2 Compares nutrition screening results with normative references to
determine the nutritional risk level of individuals.
2.2.3 Determines the appropriate service and referral needs.
Nutrition Assessment
2.3.1 Conducts a nutrition assessment on individuals with less complex or less
acute nutritional health care needs when environmental supports are in
place.
2.3.2 Collects, assesses and interprets vital signs and anthropometric measures.
2.3.3 Collects routine biochemical tests (e.g. capillary blood glucose levels).
2.3.4 Identifies abnormal and normal biochemical values and medical
test/procedure results.
2.3.5 Determines barriers that might influence a client/patient’s nutritional
status.
2.3.6 Determines accuracy and currency of the nutrition assessment data.
Diagnosis
2.3.7 Analyzes and synthesizes nutrition assessment data to inform nutrition
diagnosis(es) and plan of care.
2.3.8 Identities the appropriate validated formulas and performs calculations to
determine nutritional requirements.
121
Table 27. cont.
Unit 2: Client/Patient Services (cont.)
Competencies
Performance Indicators
2.3 (cont.)
Diagnosis (cont.)
2.3.9 Creates PES (problem, etiology and sign or symptom) statement and
outlines reasons for professional opinion, cause and contributing factors.
2.3.10 Prioritizes the nutrition diagnosis(es).
2.3.11 Determines the need to consult, transfer nutrition care or refer to others.
Intervention
2.3.12 Recommends an individualized plan of care that addresses nutritional
care needs, diagnosis and client/patient goals in collaboration with the
client/patient and team members.
2.3.13 Implements plan of care or intervention in collaboration with the
client/patient and other team members.
Monitoring/Evaluation
2.3.14 Monitors and evaluates problems, etiology, signs or symptoms and
impact of intervention on the nutrition diagnosis.
2.3.15 Applies standardized nutrition care outcome indicators to measure
nutrition interventions.
2.3.16 Assesses client/patient’s understanding and compliance with nutrition
intervention.
2.3.17 Identifies barriers to meeting client/patient’s nutrition goals.
2.3.18 Summarizes impact of the sum of all interventions on overall
client/patient’s nutrition outcomes.
2.3.19 Identifies reasons for deviation from expected nutrition outcomes for a
given nutrition intervention for client/patient.
2.3.20 Makes and implements modifications to the plan of care or nutritional
intervention in collaboration with the client/patient and health care
team.
Documentation
2.3.21 Documents all elements of the nutrition care process following
professional standards and organizational policies.
2.3.22 Applies coding and billing procedures and policies for nutrition and
dietetics services to obtain reimbursement from public and private
insurers.
2.4
Medical Nutrition Therapy
Performs nutritional
interventions for
client/patient with
less complex
nutrition care needs
when environmental
supports are in
place.
2.4.1 Ensures environmental supports are in place prior to implementing the
plan of care.
2.4.2 Manages medical nutrition therapy for clients/patients whose condition
or nutritional status is less complex and plan of care, nutrition diagnosis
and prognosis are clearly established.
2.4.3 Applies and integrates understanding of foundational sciences to manage
medical nutrition therapy.
122
Table 27. cont.
Unit 2: Client/Patient Services (cont.)
Competencies
Performance Indicators
2.4 (cont.)
Medical Nutrition Therapy (cont.)
2.4.4 Applies foundational science knowledge and medical nutrition therapy
principles to manage oral diets and oral nutritional supplements.
2.4.5 Monitors tolerance of enteral feedings and adherence to nutrition
recommendations for client/patient’s whose nutrition therapy has been
well established.
2.4.6 Considers client/patient complexity, nutritional impact, indications, side
effects, contraindications, benefits, alternatives and foundational sciences
when recommending the use of nutritional supplements.
2.4.7 Transfers nutrition care to registered dietitian nutritionist or physician
when client/patient needs become more complex, when environment
changes or when required nutrition intervention is beyond personal
competence or professional scope of practice.
Education
2.4.8 Applies education theories, adult learning, pedagogy and education
principles.
2.4.9 Assesses audience’s readiness to learn and identifies barriers to learning
including client/patient and environmental factors.
2.4.10 Modifies nutrition education materials or delivery methods to meet the
needs of the client/ patient or group.
2.4.11 Provides evidence-informed nutrition education to clients/patients and
groups.
2.4.12 Translates basic food and general nutrition knowledge into
understandable language tailored to the audience.
2.4.13 Evaluates effectiveness of nutrition education and makes modifications
as required.
Coaching and Counseling
2.4.14 Assesses a client/patient’s needs and appropriateness for the
recommended counseling or coaching.
2.4.15 Applies coaching and counseling principles when providing individualized
sessions to clients/patients whose needs are less complex and when
workplace supports are in place.
2.4.16 Evaluates effectiveness of coaching or counseling and makes
modifications as required.
2.4.17 Refers to other professionals when client/patient needs are beyond
personal competence or professional scope of practice.
2.5
Considers the
client/patient’s use
of integrative and
functional nutrition
and related beliefs
and values.
2.5.1 Demonstrates awareness of integrative and functional nutrition
interactions.
2.5.2 Recommends nutritional supplements based on nutrition assessment,
while adhering to the professional standards and evidence-informed
practice.
123
Table 27. cont.
Unit 3: Food Systems Management
Applies food system principles and management skills to ensure safe and efficient delivery of food and
water.
Competencies
Performance Indicators
3.1
3.1.1 Plans, designs and coordinates nutritionally sound meals that meet
client/patient’s needs and promote nutritional health and disease
management.
Manages the
production,
distribution and
service of quantity
and quality of food
products.
3.2
Coordinates the
purchasing, receipt
and storage of food
products and
services.
3.1.2 Ensures work activities and products reflect the organization’s mission.
3.1.3 Investigates and optimizes opportunities to reduce the environmental
carbon footprint of foodservice operations and to enhance sustainability.
3.1.4 Implements the use of new kitchen or dietary processes to facilitate
efficient and effective services.
3.2.1 Conducts a facility analysis of equipment and technological needs based
on resource availability, anticipated future growth and sustainability.
3.2.2 Identifies and analyzes the need to engage internal or external
stakeholders in an agreement or contract.
3.2.3 Applies ethical negotiation skills to manage contracts and professional
agreements.
3.2.4 Coordinates human and financial resources to assure appropriate
inventory control.
3.2.5 Develops, implements and uses inventory management systems to track
and ensure accurate inventory reporting.
3.2.6 Analyzes inventory control as it pertains to the food and supplies of the
foodservice operation.
3.2.7 Manages the process of receiving and storing products, demonstrating
adherence to food safety code guidelines and regulations.
3.2.8 Manages the relationship between forecasting and production as it
pertains to recipe needs and organizational demand.
3.3
Applies principles of
food safety and
sanitation to the
production and
service of food.
3.3.1 Maintains currency in and follows applicable legislation and guidelines.
3.3.2 Follows the required safety and legislation, regulations, guidelines,
policies and procedures applicable to the practice setting environment
and services provided.
3.3.3 Manages activities related to compliance with health and safety
requirements.
3.3.4 Applies and educates others on food safety principles.
3.3.5 Identifies local vulnerabilities in the food supply chain as it relates to
bioterrorism, natural disasters and food contamination.
3.3.6 Adheres to and educates other on infection prevention and control
measures.
3.3.7 Supports the implementation of an emergency preparedness plan and
distribution of services pertaining to foodservice operations.
124
Table 27. cont.
Unit 3: Food Systems Management (cont.)
Competencies
Performance Indicators
3.4
3.4.1 Has a working knowledge of different agricultural food production
systems and related terminology.
Applies an
understanding of
agricultural practices
and processes.
3.4.2 Identifies the need and establishes partnerships with local growers and
producers.
Unit 4: Community and Population Health Nutrition
Applies community and population nutrition health theories when providing support to community or
population nutrition programs.
4.1
Works
collaboratively with
others to assesses,
implement and
evaluate community
and population
based programs.
4.1.1 Conducts an assessment of the practice setting, competitive landscape
and stakeholder opinions to identify and evaluate data needed to make
decisions regarding nutrition products, programs and services.
4.1.2 Identifies opportunities for nutrition intervention and improvement.
4.1.3 Utilizes strategies to evaluate effectiveness, analyzing reasons for
variance from expected outcome, and implements new strategies as
appropriate.
4.1.4 Collaborates with appropriate stakeholders to support the
implementation of the nutrition program plan.
4.1.5 Applies an evaluation framework, using approved tools and methods, to
support the evaluation of the community nutrition program.
4.1.6 Makes modifications to the nutrition program or services based on data
and in collaboration with others.
Unit 5: Leadership, Business, Management and Organization
Demonstrates leadership, business and management principles to guide practice and achieve
operational goals.
5.1
Demonstrates
leadership skills to
guide practice.
5.1.1 Demonstrates understanding of social situations and dynamics, and ability
to operate effectively in a variety of social environments.
5.1.2 Communicates at the appropriate emotional level, and understands
emotions and emotional situations.
5.1.3 Develops interpersonal skills by becoming an active listener and having
strong conversational and speaking skills.
5.1.4 Sees other’s perspectives and is open to and considers other’s points of
view.
125
Table 27. cont.
Unit 5: Leadership, Business, Management and Organization (cont.)
Competencies
Performance Indicators
5.2
Planning
Applies principles of
organization
management.
5.2.1 Works within an established operational plan by monitoring budget,
inventory control, labor and regular daily tasks.
5.2.2 Aligns work and department activities with organizational strategic plan,
mission and vision.
Organizing
5.2.3 Assigns responsibilities to various team members according to scope of
practice and personal competence.
5.2.4 Sets and monitors clear targets for team members that are aligned with
common objectives and goals.
Management
5.2.5 Engages in human resource activities adhering to applicable legislation
and regulations.
5.2.6 Applies understanding of psychological and sociological perspectives
when managing staff and engaging in human resource activities.
5.2.7 Applies change management theories and conflict resolution skills to
manage and promote positive change.
5.2.8 Uses persuasive communication skills to influence and produce a desired
outcome during negotiations and conflict resolution discussions.
5.2.9 Understands and respects roles and responsibilities of the
interprofessional team members.
Controls
5.2.10 Collects, understands and analyzes financial data to support fiscally
responsible decision making.
5.2.11 Collects and reports data to support the analysis of the department’s
operational plan and budget.
Time Management
5.2.12 Applies principles of time management to monitor and enhance personal
productivity and productivity of others.
5.2.13 Prioritizes activities to effectively manage time and workload.
5.2.14 Evaluates the whole system.
Motivation and Recognition
5.2.15 Demonstrates appreciation for team involvement and the value and skills
of each member.
5.2.16 Models behaviors that maximize group participation by consulting,
listening and communicating clearly.
5.2.17 Takes innovative approaches to build support and maintain a diverse
workforce.
126
Table 27. cont.
Unit 5: Leadership, Business, Management and Organization (cont.)
Competencies
Performance Indicators
5.3
5.3.1 Collaborates with others to define the project scope and project plan.
Applies project
management
principles to achieve
project goals and
objectives.
5.3.2 Monitors approved project plan to ensure deliverables are met within
scope of the project scope, time and cost.
5.4
5.4.1 Establishes goals for improving quality of services in collaboration with
others.
Incorporates quality
improvement into
nutrition and dietetic
practice.
5.3.3 Reports potential and real risk and suggests options to resolve the risk.
5.4.2 Identifies quality improvement indicators and supports the development
of quality improvement measurement tools.
5.4.3 Participates in the development of policies and performance measures for
quality and quantity of work.
5.4.4 Ensures compliance with external standards, collects data and reports
findings.
5.4.5 Collects data to assess the quality of services provided and identifies
opportunities for improvement.
5.4.6 Evaluates and analyzes data, reports findings and makes
recommendations for quality improvement.
5.4.7 Communicates and collaborates with relevant stakeholders to implement
changes to improve effectiveness and efficiency.
5.5
Incorporates risk
management
strategies into
practice.
5.5.1 Assesses potential and real risks to an individual, group and or
organization.
5.5.2 Identifies and takes action to manage, reduce and or eliminate risk or
hazards to self, others and the organization.
5.5.3 Supports implementation of risk management plan.
Unit 6: Critical Thinking, Research and Evidence-Informed Practice
Integrates evidence-informed practice, research principles, and critical thinking into practice.
6.1
Incorporates critical
thinking skills in
overall practice.
6.1.1 Identifies how critical thinking allows for consideration of multiple factors
when problem solving.
6.1.2 Incorporates the thought process used in critical thinking models.
6.1.3 Engages in reflective practice to promote change and continuous learning.
6.2
6.2.1 Identifies basic steps of the scientific method and scientific processes.
Identifies and
understands the
scientific method
and research ethics.
6.2.2 Recognizes research ethics and responsible conduct in research.
6.2.3 Collects and retrieves data using a variety of methods and technologies.
6.2.4 Communicates pre-developed research messaging to a variety of
audiences.
127
Table 27. cont.
Unit 6: Critical Thinking, Research and Evidence-Informed Practice (cont.)
Competencies
Performance Indicators
6.3
Applies current
research and
evidence-informed
practice to services.
6.3.1 Uses resources to find accurate and current research and evidence-based
literature.
6.3.2 Understands basic components of assessing the strengths and limitations
of research articles.
6.3.3 Uses research terminology when communicating with other professionals.
6.3.4 Evaluates current research and evidence-based practice findings to
determine the reliability and credibility of information.
6.3. 5 Applies current research and evidence-informed practice to the deliver
safe and effective nutrition care.
Unit 7: Professionalism
Assumes professional responsibilities to provide safe, ethical and effective nutrition services.
7.1
Demonstrates
ethical behaviors in
accordance to the
professional Code of
Ethics.
7.1.1 Demonstrates honesty and integrity, and behaves in a trustworthy,
transparent, respectful and non-judgmental manner toward
clients/patients and colleagues.
7.1.2 Understands governance of nutrition and dietetics practice as outlined in
documents such as the Scope of Nutrition and Dietetics Practice and the
professional Code of Ethics.
7.1.3 Accepts responsibility and accountability for own actions and decisions.
7.1.4 Practices in a manner that respects diversity and avoids prejudicial
treatment of an individual, group or population.
7.1.5 Understands the impact of the client/patient-provider relationship on
services.
7.1.6 Applies client/patient-centered principles to all activities and services.
7.1.7 Recognizes and maintains professional boundaries with clients/patients.
7.1.8 Analyzes the impact of one’s own professional behaviors, values, beliefs
and actions on others.
7.1.9 Develops advertising and marketing materials that are accurate, truthful
and evidence-informed.
7.1.10 Applies principles of the informed consent process to ensure the
client/patient is capable of accepting or refusing services.
7.1.11 Advocates for and takes action to ensure others demonstrate
professional responsibilities and ethical behaviors
7.1.12 Recognizes and take steps to manage ethical dilemmas.
7.2
Engages in selfreflective practice to
maintain ongoing
competence and
professional
behaviors.
7.2.1 Demonstrates continuous self-awareness by critically evaluating one’s
knowledge, skill, judgment and learning and leadership style.
7.2.2 Obtains feedback and demonstrates a willingness to consider opinions of
others.
7.2.3 Considers and incorporates own experiences and learning in practice.
7.2.4 Develops personal learning goals and objectives, and identifies activities
to meet these goals.
7.2.5 Incorporates learning to ensure safe ethical and competent nutrition care.
128
Table 27. cont.
Unit 7: Professionalism (cont.)
Competencies
Performance Indicators
7.3
Adheres to nutrition
related legislation,
regulations and
standards of
practice.
7.3.1 Adheres to confidentiality and privacy legislation, practice standards and
organization’s policies regarding client/patient information.
7.3.2 Demonstrates awareness of all mandatory reporting obligations.
7.3.3 Obtains consent for the collection, use, sharing, storage and release of
personal information.
Unit 8: Communication, Collaboration and Advocacy
Uses effective communication with others to achieve common goals and enhance relationships in the
provision of nutrition and dietetics services.
8.1
8.1.1 Communicates in a clear, effective and respectful manner.
Applies effective and
ethical
communication skills
and techniques to
achieve desired goals
and outcomes.
8.1.2 Selects mode of communication appropriate to the messaging to meet
the needs of the audience.
8.1.3 Identifies and addresses barriers to communication.
8.1.4 Adapts communication style to meet needs of diverse individuals and
groups.
8.1.5 Uses active listening techniques.
8.1.6 Interprets and responds to nonverbal communications.
8.1.7 Understands and applies media communication principles including
presenting with poise, developing key points, conveying scientific
accuracy, and translating to consumer language.
8.1.8 Ensures timely, clear and accurate documentation using correct spelling
and grammar, following the standards of the profession and
organizational policies.
8.1.9 Demonstrates proficient use of nutrition informatics.
8.2
Works with and
facilitates
intraprofessional and
interprofessional
collaboration and
teamwork.
8.2.1 Demonstrates networking skills to build liaisons with internal and
external stakeholders.
8.2.2 Seeks consultation and refers to other professionals when needed.
8.2.3 Networks with internal and community professional groups and
organizations.
8.2.4 Demonstrates understanding of meeting management principles by
effectively facilitating meetings and small group activities to achieve goals
within time frames.
8.2.5 Demonstrates knowledge of the interprofessional team members’ scope
of practice and competence.
8.2.6 Supports others in meeting their professional obligations.
8.2.7 Functions as member of the interprofessional team to support a
collaborative client/patient-centered approach.
8.2.8 Understands the mentoring role and practices mentoring or precepting
others.
129
Table 27. cont.
Unit 8: Communication, Collaboration and Advocacy (cont.)
Competencies
Performance Indicators
8.3
8.3.1 Advocates for the profession by communicating to others the role, scope
of practice and areas of expertise of the profession.
Demonstrates
advocacy skills to
promote awareness
and required change.
8.3.2 Participates in advocacy activities to change or promote new legislation
and regulation.
130
Table 28. Proposed competencies and performance indicators for future master degree programs
Unit 1: Foundational Knowledge
Applies foundational sciences to food and nutrition knowledge to meet the needs of individuals,
groups, and organizations.
Competencies
Performance Indicators
1.1
1.1.1 Analyzes the usefulness and limitations of epidemiological study designs
and identifies trends in diet and disease.
Applies an
understanding of
environmental and
genetic factors and
food in the
development and
management of
disease.
1.1.2 Examines issues in relation to gene nutrient interactions.
1.1.3 Communicates epidemiological evidence related to the relationship
between diet and the development of disease.
1.1.4 Demonstrates an understanding of research techniques and processes
used to study the effects of genetics on disease states.
1.1.5 Identifies the influence of food consumption on the development of
diseases.
1.1.6 Supports management of food consumption to treat acute and chronic
diseases.
1.2
1.2.1 Analyzes the impact of food and nutrition on physiological processes.
Applies an
understanding of
anatomy and
physiology.
1.2.2 Integrates knowledge of anatomy and physiology to make decisions
related to nutrition care.
1.3
1.3.1 Applies the proper methods of microbial control in food and the
environment.
Applies knowledge
of microbiology and
food safety.
1.2.3 Communicates an understanding of the human body and the impact of
food and nutrition on body systems.
1.3.2 Applies food safety principles of microbiological food spoilage and
strategies for controlling microbial growth.
1.3.3 Applies principles of pathogens microbes, viruses and fungi as it relates to
food safety principles and across all stages of the life cycle and
physiological state of the individual.
1.3.4 Implements key principles and practices to make foods safe for
consumption at all stages during the flow of food.
1.4
Integrates
knowledge of
chemistry and food
science as it pertains
to food and nutrition
product
development and
when making
modifications to
food.
1.4.1 Summarizes and analyzes the impact of fundamental chemistry and
organic chemistry principles on food, human health and metabolism.
1.4.2 Integrate nutritional biochemistry knowledge to make informed
recommendations.
1.4.3 Analyzes the chemical nature of food and the impact on food quality,
acceptability and compatibility.
1.4.4 Analyzes the food components and the chemical elements for food and
nutrition products.
131
Table 28. cont.
Unit 1: Foundational Knowledge (cont.)
Competencies
Performance Indicators
1.5
1.5.1 Examines nutritional biochemical indicators specific to the disease
process.
Demonstrates and
applies knowledge of
patho-physiology
and biochemical
functionality and
their relationship to
physiology, health
and disease.
1.6
Applies knowledge
of social,
psychological and
environmental
aspects of eating and
food.
1.5.2 Interprets and analyzes the effect of diet, fluids, electrolytes and
nutritional status on the development and progress of the disease
process.
1.5.3 Interprets and analyzes the effects of disease, clinical condition and
treatment on nutritional health status.
1.5.4 Analyzes the correlation between mental health conditions and
nutritional health.
1.6.1 Formulates food and nutrition services considering psychological and
social factors to meet the needs of individuals, communities and
populations.
1.6.2 Articulates the impact of nutritional health on psychiatric disorders.
1.6.3 Integrates knowledge of maximizing sustainability, food and water waste,
reusable/ biodegradable items, local and global produce sourcing and
access to food.
1.6.4 Analyzes the environmental factors affecting access to services and/or
adequate nutrition.
1.7
1.7.1 Demonstrates knowledge of the cultural competence models.
Integrates the
principles of cultural
competence within
own practice and
when directing
services.
1.7.2 Applies knowledge of foods, cultural foods, eating patterns and food
trends.
1.7.3 Identifies challenges that arise when different cultures, values, beliefs and
experiences exist between clients/patients and nutrition and dietetics
professionals.
1.7.4 Identifies and implements strategies to address cultural biases and
differences.
1.7.5 Applies culturally sensitive approaches and communication skills.
1.7.6 Develops self-awareness of one’s own personal beliefs, values and biases
to better serve clients/patients of different cultures and backgrounds.
1.8
Applies knowledge
of pharmacology and
integrative and
functional nutrition
to recommend,
prescribe and
administer medical
nutrition therapy.
1.8.1 Identifies the classifications of nutraceutical pharmacological agents and
the action of the body.
1.8.2 Demonstrates understanding of pharmacokinetics, absorption, clearance,
drug metabolism, latency period, drug and supplement metabolism,
accumulation, half-life, and routes of administration.
1.8.3 Identifies potential drug and food interactions based on physiological
responses to pharmacological agents and takes appropriate actions.
1.8.4 Describes the clinical use of nutritional therapies.
1.8.5 Critically evaluates evidence-based literature and resources related to
integrative and functional nutrition.
1.8.6 Identifies the purpose, risks, advantages, disadvantages and
contraindications of commonly used nutritional therapies.
132
Table 28. cont.
Unit 1: Foundational Knowledge (cont.)
Competencies
Performance Indicators
1.9
1.9.1 Chooses appropriate statistical methods and applies them in various data
analysis situations.
Applies knowledge
of math and
statistics.
1.9.2 Performs statistical analysis and interprets results.
1.9.3 Applies statistical concepts in interpretation of nutrition related data.
1.9.4 Performs data analysis using various statistical software.
1.9.5 Communicates statistical methods and results both orally and in writing.
1.9.6 Applies mathematical concepts and problem solving in nutrition and food
related activities.
1.10
Applies knowledge
of medical
terminology when
communicating with
individuals, groups
and other health
professionals.
1.10.1 Interprets and communicates medical terminology to non-health
professional audiences.
1.10.2 Uses acceptable medical abbreviations and appropriate medical
terminology in oral and written communication.
1.10.3 Demonstrates understanding of common terms used by other disciplines.
1.11
1.11.1 Understands appropriate cooking skills and techniques.
Demonstrates
knowledge of food
preparation
techniques.
1.11.2 Demonstrates understanding of safe work habits and safety hazards and
employs preventive safety measures.
1.11.3 Converts recipes and ingredients based on client/patient’s preferences
or dietary needs.
1.11.4 Develops recipes and menus.
1.11.5 Ensures foods are aesthetically pleasing, appealing and tasteful.
1.12
Applies nutrition
informatics in the
decision making
process.
1.12.1 Analyzes data derived from electronic media to make best decisions
related to nutrition and diet.
1.12.2 Evaluates accuracy and reliability when accessing and evaluating
nutrition information online.
1.12.3 Designs and operates nutrition informatics systems in practice.
1.12.4 Analyzes electronic databases to obtain nutrition information and
evaluate credible sources in decision making.
1.12.5 Proficiently uses new technology to enhance practice and client/patient
care.
1.13
Integrates
knowledge of
nutrition and
physical activity in
the provision of
nutrition care at all
stages of the life
cycle.
1.13.1 Analyzes, integrates and communicates nutritional requirements related
to all stages of the life cycle.
1.13.2 Identifies nutritional risk factors across all stages of the life cycle.
1.13.3 Explains the general impact of exercise and physical activity on nutrition
needs throughout the life cycle.
1.13.4 Teaches the benefits of exercise at all stages of the life cycle to
individuals, groups and populations.
1.13.5 Explains and takes into consideration how nutrients, nutritional
supplements and hydration influence physical activity and dimensions
wellness.
133
Table 28. cont.
Unit 1: Foundational Knowledge (cont.)
Competencies
Performance Indicators
1.14
1.14.1 Recognizes and communicates the cause of disease and nutrition risks.
Applies knowledge
of nutritional health
promotion and
disease prevention
for individuals,
groups and
populations.
1.14.2 Identifies and implements health risk reduction strategies for individuals,
groups and populations.
1.14.3 Prioritizes dimensions of wellness as a result of a nutrition assessment.
1.14.4 Interprets the impact of demographic and socio economic factors and
ecological issues on nutritional well-being of individuals, groups and
populations.
1.14.5 Examines the influences of society, media, culture and peer pressure on
dimensions of wellness.
1.14.6 Designs food and nutrition activities for various audiences considering
factors relevant to individuals, groups and communities.
1.14.7 Educates others on the effects of deficiencies and toxicities of nutrients
on nutritional health.
1.14.8 Applies behavior change theories for nutritional health promotion and
disease prevention.
1.15
Gains a foundational
knowledge on global
health issues and
nutritional needs.
1.15.1 Examines the trends and current issues that impact public health from
existing, new and reemerging diseases that spread through immigration,
travel and global trade.
1.15.2 Examines the impact of global food supply and sustainability and related
factors.
1.15.3 Examines how globalizing processes impact nutrition, nutrition education
and nutrition related diseases in developing countries.
1.15.4 Analyzes public policies to inform and shape policy briefs, short
commentaries and longer papers.
Unit 2: Client/Patient Services
Applies and integrates client/patient-centered principles and competent nutrition and dietetics
practice to ensure positive outcomes.
2.1
Uses a framework to
assess, develop,
implement and
evaluate products,
programs and
services.
2.1.1 Conducts or coordinates an assessment of the environment, competitive
landscape and stakeholder opinions to identify and evaluate data needed
to make decisions regarding nutritional products, programs and services.
2.1.2 Conducts feasibility studies to determine validity and need for the
nutritional programs, services or products.
2.1.3 Identifies and collaborates with stakeholders.
2.1.4 Designs nutritional products, programs or services that promote
consumer nutritional health and dimensions wellness, and lifestyle
management.
2.1.5 Creates a work plan or project plan to implement nutritional programs
and services or launch products.
134
Table 28. cont.
Unit 2: Client/Patient Services (cont.)
Competencies
Performance Indicators
2.1 cont.
2.1.6 Implements activities to ensure nutritional program, product or service
goals are met.
2.1.7 Develops strategies to evaluate effectiveness of nutritional program,
product or service by analyzing reasons for variance from expected
outcomes and implements new strategies for continuous quality
improvement.
2.2
Selects, develops or
implements
nutritional status
screening tools for
individuals, groups
or populations.
2.2.1 Selects or develops nutrition screening tools taking into consideration all
client/patient factors.
2.2.2 Evaluates the validity and reliability of the nutrition screening tools and
modifies based on current evidence-informed practice.
2.2.3 Identifies appropriate resources needed to complete nutrition screening.
2.2.4 Implements nutrition screening tools in collaboration with other health
professionals.
2.2.5 Determines the complexity of the client/patient care needs, appropriate
care provider and required environment supports.
2.3
Utilizes the nutrition
care process with
individuals, groups
or populations in a
variety of practice
settings.
Nutrition Assessment
2.3.1 Conducts a nutrition focused physical exam.
2.3.2 Takes a food and nutrition related medical history.
2.3.3 Assesses physical activity and history of physical activity and exercise.
2.3.4 Collects, assesses and interprets anthropometric measures and body
composition.
2.3.5 Orders, collects and interprets biochemical tests.
2.3.6 Analyzes diagnostic test results relevant to nutrition (e g. diagnostic
imaging related to fluoroscopy, swallowing evaluation, enteral feeding
tube placement).
2.3.7 Identifies signs and symptoms of nutrient deficiencies or excesses.
2.3.8 Determines barriers that might influence a client/patient’s nutritional
status.
2.3.9 Determines accuracy and currency of nutrition assessment data.
Diagnosis
2.3.10 Analyzes and synthesizes nutrition assessment data to inform nutrition
diagnosis(es) and nutritional plan of care.
2.3.11 Identifies the appropriate validated formula and performs calculations to
determine nutritional requirements.
2.3.12 Devises PES (problem, etiology and sign symptom) statement and
outlines reasons for professional opinion cause and contributing factors.
2.3.13 Prioritizes the nutrition diagnosis(es).
2.3.14 Determines the need to consult and refer/transfer nutrition care to
others.
135
Table 28. cont.
Unit 2: Client/Patient Services (cont.)
Competencies
Performance Indicators
2.3 (cont.)
Intervention
2.3.15 Develops an individualized plan of care that addresses nutritional care
needs diagnosis and client nutrition goals in collaboration with the
client/patient and team members.
2.3.16 Orders nutrition prescriptions to address nutritional goals.
2.3.17 Implements or facilitates the implementation of the nutrition plan of care
or nutrition intervention with the patient and other team members.
Monitoring/Evaluation
2.3.18 Monitors and evaluates problems, etiology, signs and symptoms and
impact of nutrition intervention on the nutrition diagnosis.
2.3.19 Develops and applies nutrition care outcome indicators to measure
nutrition intervention.
2.3.20 Assesses client/patient’s understanding and compliance with nutrition
intervention.
2.3.21 Identifies barriers to meeting client/patient’s nutrition goals and makes
recommendations to modify the nutrition plan of care or nutrition
intervention, and communicates changes to client/patient and others.
2.3.22 Summarizes impact of the sum of the nutrition interventions on
client/patient’s nutrition outcomes, considering client/patient-centered
care.
2.3.23 Identifies, analyzes and communicates reasons for deviation from
expected nutrition outcomes.
2.3.24 Evaluates the availability of services to support access to nutrition care
and to help meet client/patient nutrition goals.
Documentation
2.3.25 Documents all elements of the nutrition care process following
professional standards and organizational policies.
2.3.26 Demonstrates coding and billing procedures and follows policies for
nutrition and dietetics services to obtain reimbursement from public and
private insurers.
2.4
Medical Nutrition Therapy
Performs or
coordinates
nutritional
interventions for
individuals, groups
or populations.
2.4.1 Manages medical nutrition therapy for clients/patients.
2.4.2 Applies and integrates understanding of foundational sciences to manage
medical nutrition therapy, diet and disease management.
2.4.3 Applies foundational science knowledge and medical nutrition therapy
principles to establish, order, manage and evaluate the need for nutrition
support when prescribing and administering nutritional oral, enteral and
parenteral diets.
136
Table 28. cont.
Unit 2: Client/Patient Services (cont.)
Competencies
Performance Indicators
2.4 (cont.)
Medical Nutrition Therapy cont.
2.4.4 Considers and applies knowledge of nutritional impact, indications, side
effects, contraindications, benefits and alternatives when recommending
the use of nutritional supplements.
2.4.5 Transfers care to relevant professionals when patient needs or required
interventions are beyond personal competence or professional scope of
practice.
Education
2.4.6 Applies education theories, adult learning, pedagogy and education
principles.
2.4.7 Assesses audience’s readiness to learn and identifies barriers to learning.
2.4.8 Modifies nutrition education materials or delivery methods to meet the
needs of the audience.
2.4.9 Develops and provides evidence-informed nutritional wellness and
therapeutic diet education to variety of audiences.
2.4.10 Translates basic to advanced food and nutrition science knowledge into
understandable language tailored to the audience.
2.4.11 Communicates complex nutrition information to broad and diverse
audiences.
2.4.12 Evaluates effectiveness of nutrition education and makes modifications
as required.
Psychological Counseling and Therapies
2.4.13 Assesses client/patient’s nutritional needs and appropriateness for the
recommended counseling or therapy.
2.4.14 Applies counseling principles and evidence-informed practice when
providing individual or group sessions.
2.4.15 Identifies the indications, contraindications, benefits, risks and limitations
of the counseling or therapy.
2.4.16 Demonstrates understanding of transference and counter transference in
the therapeutic relationship.
2.4.17 Demonstrates awareness of various appropriate psychological counseling
techniques (e.g. cognitive therapy, behavior modification, motivational
interviewing).
2.4.18 Evaluates effectiveness of the counseling or therapy and makes
modifications as required.
2.4.19 Refers to other professionals when counseling therapy or client/patient’s
mental health issues are beyond personal competence or professional
scope of practice.
137
Table 28. cont.
Unit 2: Client/Patient Services (cont.)
Competencies
Performance Indicators
2.5
2.5.1 Applies knowledge of foundational sciences and disease when
determining the appropriateness of the therapy.
Prescribes or
recommends
nutrition-related
pharmacotherapy
and integrative and
functional nutrition.
2.5.2 Demonstrates awareness of alternative and complementary therapy and
drug interactions.
2.5.3 Assesses client/patient factors to determine the client/patient’s
indication for the nutrition related pharmacotherapy.
2.5.4 Considers client/patient factors, nutritional impact, indications, side
effects, contraindications, benefits, risks, alternatives and foundational
sciences when prescribing or administering nutrition related drug
therapy.
2.5.5 Critically analyzes the potential negative effects of the nutrition therapy
or supplement and determines the required knowledge, skill and
judgment required to manage negative outcomes.
2.5.6 Prescribes or administers nutrition related pharmacotherapy and
integrative and functional nutrition adhering to the professional
standards and evidence-informed practice.
2.5.7 Applies the standard of practice, legislation, organizational policies and
evidence-informed practices for prescribing.
2.5.8 Applies the principles of safe drug administration.
2.5.9 Monitors the response and the effects of the nutrition related drug,
supplement and integrative and functional nutrition on the individual and
takes the required action to make modifications or adjustments.
2.5.10 Consults and refers client/patient to another professional when
client/patient’s needs are beyond personal competence or professional
scope of practice.
Unit 3: Food Systems Management
Applies food systems principles and management skills to ensure safe and efficient delivery of food
and water.
3.1
Oversees the
production and
distribution of
quantity and quality
of food products.
3.1.1 Manages or oversees the planning, designing and coordination of meals
to ensure delivery of nutritionally sound meals.
3.1.2 Analyzes the workflow design and makes recommendations for
modifications or approves for implementation.
3.1.3 Communicates the organization’s mission and how work activities impact
the clients/patients and organization.
3.1.4 Establishes and analyzes policies and performance measures for quality
and quantity of work.
3.1.5 Implements systems to report on local, state and federal compliance.
3.1.6 Directs and analyzes the evaluation of foodservice production and
services to inform, change, and/or budget resources and department or
corporate direction.
3.1.7 Establishes a culture that is ethical and free of safety and health hazards.
3.1.8 Investigates and optimizes opportunities to reduce the environmental
carbon footprint of foodservice operations and to enhance sustainability.
138
Table 28. cont.
Unit 3: Food Systems Management (cont.)
Competencies
Performance Indicators
3.2
3.2.1 Follows a matrix or measures to evaluate the need for financial, technical
and equipment resources for the provision of foodservices.
Oversees the
purchasing, receipt
and storage of
products used in
food production and
services.
3.2.2 Applies ethical decision making to determine the need for reduction or
increase in resources.
3.2.3 Creates internal or external professional relations and/or agreementsto
solve problems in foodservice operations.
3.2.4 Acts as a departmental and organizational liaison between contractual
parties involved.
3.2.5 Demonstrates knowledge of inventory control as it pertains to the food
and supplies of the foodservice operation.
3.2.6 Applies the principles of the process of receiving and storing products
demonstrating adherence to food safety code, nutrition guidelines and
regulations.
3.2.7 Applies the relationship between forecasting and production as it pertains
to recipe needs and organizational demand.
3.3
Applies principles of
food safety and
sanitation to the
production and
service of food.
3.3.1 Maintains currency in and follows applicable legislation and guidelines.
3.3.2 Monitors staff compliance with laws, policies and procedures.
3.3.3 Incorporates the required safety and nutritional health policies and
procedures in the organization’s mission and policies.
3.3.4 Identifies local and global vulnerabilities in the food supply chain as it
relates to bioterrorism, natural disasters and food contamination.
3.3.5 Ensures systems are in place to encourage compliance with nutritional
health and safety requirements and infection control measures.
3.3.6 Develops and facilitates the implementation of an emergency
preparedness plan and distribution of services pertaining to local, state
and global foodservice operations and feeding programs.
3.4
Applies and
demonstrates an
understanding of
agricultural practices
and processes.
3.4.1 Has a working knowledge of different agricultural food production
systems and related terminology and concepts including potential
nutritional impact.
3.4.2 Understands the local and global food markets and applicable nutrition
regulations.
3.4.3 Identifies and supports partnerships with local and global food growers
and producers.
139
Table 28. cont.
Unit 4: Community and Population Health Nutrition
Applies community and population nutrition health theories when providing support to community or
population nutrition programs.
Competencies
Performance Indicators
4.1
4.1.1 Demonstrates knowledge of public health, health promotion and
population nutrition health principles.
Follows
programming
planning steps to
develop and
implement
community,
population and
global programs.
4.1.2 Recognizes how determinants of health influence the nutrition health and
well-being of a population.
4.1.3 Develops and conducts community and population based assessments
considering all relevant factors.
4.1.4 Identifies and documents epidemiological findings, health disparities,
political interests, impacts of determinants of health, availability of
resources, accessibility and program goals and objectives.
4.1.5 Identifies the resources and partners needed for sustainability of the
program.
4.1.6 Considers the assessment data and potential strengths, benefits,
constraints and limitations when developing the program.
4.1.7 Develops the program addressing the nutrition needs of the group,
community or population.
4.1.8 Implements program plan applying project management skills and
adhering to public nutritional health policies and standards.
4.1.9 Collects nutrition surveillance and global health and safety data and
evaluates the program using measure indicators and outcomes.
4.1.10 Communicates evaluation findings, outcomes, recommendations and
research findings to stakeholders to promote change and justify
program.
4.2
Identifies
environmental and
public health
hazards that impact
nutrition and
participates in or
coordinates the
management of the
situation.
4.3
Engages in legislative
and regulatory
activities that
address community,
population and
global nutrition
health and nutrition
policy.
4.2.1 Maintains knowledge of current environmental, food safety and nutrition
issues at a community, population and global level.
4.2.2 Investigates and analyzes key factors that impact nutrition.
4.2.3 Imparts expertise in nutrition, food safety and sustainability to key
stakeholders.
4.2.4 Recommends strategies and coordinates programs for preventing or
minimizing nutrition and food safety issues.
4.3.1 Interprets legal terminology used to establish nutrition regulations and
policies for populations.
4.3.2 Navigates governmental, intergovernmental and nongovernmental
organizations to promote proclamations of nutrition legislation and
regulations that address public, population and global nutrition health.
4.3.3 Identifies and prioritizes health disparities and security contributing to
community, population and global nutrition health issues.
4.3.4 Uses various tools to formulate and advocate for legislative and policy
changes to impact nutrition and health policies at all government levels.
140
Table 28. cont.
Unit 5: Leadership, Business, Management and Organization
Demonstrates leadership, business and management principles to guide practice and achieve
operational goals.
Competencies
Performance Indicators
5.1
5.1.1 Exhibits self-awareness in terms of personality, learning, leadership style
and cultural orientation
Demonstrates
leadership skills to
guide practice.
5.1.2 Demonstrates understanding of social situations and dynamics and ability
to operate effectively in a variety of social environments.
5.1.3 Communicates at the appropriate emotional level, understands emotions
and emotional situations and is in tune with one’s own emotions.
5.1.4 Develops interpersonal skills by becoming an active listener and having
strong conversational and speaking skills.
5.1.5 Sees others’ perspectives and is open to and considers other’s points of
view.
5.2
Planning
Applies principles of
organization
management.
5.2.1 Establishes operational plan considering budget, inventory control, labor
and regular daily tasks.
5.2.2 Aligns plans with the organizational strategic plan, mission and vision.
Organizing
5.2.3 Assigns responsibilities to various team members according to scope of
practice and personal competence.
5.2.4 Sets and monitors clear targets for team members, departments and the
organization aligned with common objectives and goals.
5.2.5 Demonstrates an understanding of how individuals and groups interact
within the organization.
5.2.6 Takes into consideration individual and organizational culture and
behaviors when planning and managing.
Management
5.2.7 Applies understanding of psychological and sociological perspectives
when managing staff and engaging in human resource activities.
5.2.8 Engages in, manages or leads human resource activities adhering to
applicable legislation and regulations.
5.2.9 Integrates change management theories and conflict resolution skills to
manage and promote positive change.
5.2.10 Uses persuasive communication skills to influence or produce a desired
outcome during negotiations and conflict resolution discussions.
5.2.11 Understands and respects roles and responsibilities of inter professional
team members.
Controls
5.2.12 Collects, understands and analyzes financial data to support fiscally
responsible decision making.
141
Table 28. cont.
Unit 5: Leadership, Business, Management and Organization (cont.)
Competencies
Performance Indicators
5.2 (cont.)
Controls (cont.)
5.2.13 Conducts cost effectiveness and cost benefit analyses to identify ways to
meet budget priorities.
5.2.14 Analyzes components of a productivity system including units of service
and work hours and makes recommendations.
5.2.15 Sets controls to analyze the progress and effectiveness of the operational
plan and budget.
5.2.16 Collects and analyzes data to evaluate outcomes and determine if
established goals and objectives are met.
5.2.17 Reevaluates the plan to make modifications to ensure positive outcomes
and that goals and objectives are met.
Time Management
5.2.18 Applies principles of time management to monitor and enhance personal
productivity and productivity of others.
5.2.19 Prioritizes activities to effectively manage time and workload.
5.2.20 Evaluates the whole system.
Motivation and Recognition
5.2.21 Promotes team involvement and values the skills of each member.
5.2.22 Models behaviors that maximize group participation by consulting,
listening and communicating clearly.
5.2.23 Takes innovative approaches to build support and maintain a diverse
workforce.
5.2.24 Coaches and advises team leaders on resolving differences or dealing
with conflict.
5.3
5.3.1 Leads the development and completion of a project plan and budget.
Applies project
management
principles to achieve
project goals and
objectives.
5.3.2 Identifies the project strengths, weaknesses, opportunities and threats.
5.4
5.4.1 Identifies and communicates quality improvement indicators and
benchmarks using evidence-based practice.
Leads quality
improvement
activities to measure
evaluate and
improve a program
services products
and initiatives.
5.3.3 Identifies and manages potential and real risks to the plan, individuals or
organization.
5.3.4 Conducts regular review of project to note strengths and opportunities for
improvement and to implement adjusted actions.
5.4.2 Develops quality improvement measurement tools and analyzes data to
inform baselines and to identify root causes and potential solutions.
5.4.3 Develops, implements and communicates a quality improvement action
plan for further improvement and monitors impact.
5.4.4 Develops, implements and communicates an ongoing measuring and
monitoring system to ensure ongoing quality improvement.
5.4.5 Applies change management theories and principles to effectively
implement change.
142
Table 28. cont.
Unit 5: Leadership, Business, Management and Organization (cont.)
Competencies
Performance Indicators
5.5
5.5.1 Assesses potential and real risks to an individual, group and or
organization.
Develops and
implements risk
management
strategies and
programs.
5.5.2 Identifies and takes action to manage, reduce and or eliminate risk to self,
others and the organization.
5.5.3 Develops risk management plans and protocols.
Unit 6: Critical Thinking, Research and Evidence-Informed Practice
Integrates evidence-informed practice, research principles, and critical thinking into practice.
6.1
6.1.1 Considers multiple factors when problem solving.
Incorporates critical
thinking skills in
managing complex
situations.
6.1.2 Incorporates the thought process used in critical thinking models.
6.2
6.2.1 Identifies, explains and applies the steps of the scientific method and
processes.
Applies scientific
methods utilizing
ethical research
practices when
reviewing,
evaluating and
conducting research.
6.1.3 Engages in reflective practice to promote change and continuous learning.
6.2.2 Articulates a clear research question or problem and formulates a
hypothesis.
6.2.3 Identifies and demonstrates appropriate research methods.
6.2.4 Interprets and applies research ethics and responsible conduct in
research.
6.2.5 Collects and retrieves data using a variety of methods (qualitative,
quantitative) and technologies.
6.2.6 Analyzes research data using appropriate data analysis techniques
(qualitative, quantitative, mixed).
6.2.7 Formulates a professional opinion based on the research findings,
evidence-informed practice and experiential learning.
6.2.8 Translates and communicates research findings and conclusions through a
variety of media to a wide range of audiences tailoring messaging
appropriate to the audience.
6.3
Applies current
research and
evidence-informed
practice to services.
6.3.1 Use resources to find accurate and current research and evidence-based
literature.
6.3.2 Uses research terminology when communicating with other professionals
and publishing research.
6.3.3 Critically examines and interprets current research and evidence-based
practice findings to determine the validity, reliability and credibility of
information.
6.3.4 Integrates current research and evidence-informed practice findings into
delivery of safe and effective nutrition care.
6.3. 5 Analyzes and formulates a professional opinion based on the current
research and evidence-based findings and experiential learning.
143
Table 28. cont.
Unit 7: Professionalism
Assumes professional responsibilities to provide safe, ethical and effective nutrition services.
Competencies
Performance Indicators
7.1
7.1.1 Demonstrates honesty and integrity and behaves in a trustworthy,
transparent, respectful and non-judgmental manner toward
clients/patients and colleagues.
Demonstrates
ethical behaviors in
accordance to the
professional Code of
Ethics.
7.1.2 Understands governance of nutrition and dietetics practice as outlined in
documents such as the Scope of Nutrition and Dietetics Practice and the
professional Code of Ethics.
7.1.3 Accepts responsibility and accountability for own actions and decisions.
7.1.4 Practices in a manner that respects diversity and avoids prejudicial
treatment of an individual, group or population.
7.1.5 Understands the impact of the client/patient-provider relationship on
services.
7.1.6 Applies client/patient-centered principles to all activities and services.
7.1.7 Recognizes and maintains professional boundaries with clients/patients.
7.1.8 Analyzes the impact of one’s own professional behaviors, values, beliefs
and actions on others.
7.1.9 Develops advertising and marketing materials that are accurate, truthful
and evidence-informed.
7.1.10 Applies principles of the informed consent process to ensure the
client/patient is capable of accepting or refusing services.
7.1.11 Advocates for and takes action to ensure others demonstrate
professional responsibilities and ethical behaviors
7.1.12 Recognizes and take steps to manage ethical dilemmas and supports
ethical decision making with team members.
7.2
Engages in selfreflective practice
activities to develop
and demonstrate
social and emotional
intelligence to
maintain ongoing
competence and
professional
behaviors.
7.3
Adheres to nutrition
related legislation,
regulations and
standards of
practice.
7.2.1 Demonstrates continuous self-awareness by critically evaluating one’s
knowledge, skill, judgment and learning and leadership style.
7.2.2 Obtains feedback and demonstrates a willingness to consider opinions of
others.
7.2.3 Considers and incorporates own experiences and learning in practice.
7.2.4 Develops personal learning goals and objectives and identifies activities to
meet these goals.
7.2.5 Incorporates learning to ensure safe ethical and competent nutrition care.
7.3.1 Adheres to confidentiality and privacy legislation, practice standards and
organization’s policies regarding client/patient information.
7.3.2 Demonstrates awareness of all mandatory reporting obligations.
7.3.3 Obtains consent for the collection, use, sharing, storage and release of
personal information.
144
Table 28. cont.
Unit 8: Communication, Collaboration and Advocacy
Uses effective communication with others to achieve common goals and enhance relationships in the
provision of nutrition and dietetics services.
Competencies
Performance Indicators
8.1
8.1.1 Communicates in a clear, effective and respectful manner.
Applies effective and
ethical
communication skills
and techniques to
achieve desired goals
and outcomes.
8.1.2 Selects mode of communication appropriate to the messaging to meet
the needs of the audience.
8.1.3 Identifies and addresses barriers to communication.
8.1.4 Adapts communication style to meet needs of diverse individuals and
groups.
8.1.5 Uses active listening techniques.
8.1.6 Interprets and responds to nonverbal communications.
8.1.7 Understands and applies media communication principles including
presenting with poise, developing key points, conveying scientific
accuracy and translating to consumer language.
8.1.8 Ensures timely, clear and accurate documentation using correct spelling
and grammar, following the standards of the profession and
organizational policies.
8.1.9 Demonstrates proficient use of nutrition informatics.
8.1.10 Analyzes communications from others to inform opinions and
impressions, gain knowledge and promote change.
8.2
Works with and
facilitates
intraprofessional and
interprofessional
collaboration and
teamwork.
8.2.1 Demonstrates networking skills to build liaisons with internal and
external stakeholders.
8.2.2 Seeks consultation and refers to other professionals when needed.
8.2.3 Networks with internal, community, state, national and global
professional groups and organizations.
8.2.4 Demonstrates understanding of meeting management principles by
effectively facilitating meetings and small group activities to achieve goals
within time frames.
8.2.5 Demonstrates knowledge of the interprofessional team members’ scope
of practice and competence.
8.2.6 Supports others in meeting their professional obligations.
8.2.7 Functions as member of the interprofessional team to support a
collaborative, client/patient-centered approach.
8.2.8 Understands the mentoring role and practices mentoring or precepting
others.
8.3
Demonstrates
advocacy skills to
promote awareness
and required change.
8.3.1 Advocates for the profession by communicating to others the role, scope
of practice and areas of expertise of the profession.
8.3.2 Participates in advocacy activities to change or promote new legislation
and regulation.
145
PUBLIC COMMENTS ON THE FIRST DRAFT
OF THE FUTURE EDUCATION MODEL ACCREDITATION STANDARDS
FOR ASSOCIATE, BACHELOR AND MASTER DEGREE PROGRAMS
IN NUTRITION AND DIETETICS
FALL 2016
PURPOSE
The purpose of this project was to gather information from various stakeholders on the draft
Future Education Model Accreditation Standards for Associate, Bachelor and Master Degree
Programs in Nutrition and Dietetics.
METHODOLOGY
ACEND® conducted an online survey (September – December, 2016) to gather stakeholder
comments related to the draft Future Education Model Accreditation Standards. A copy of the
questionnaire is included in Appendix K.
Demographics. The questionnaire was divided into six sections. The first section requested
demographic information and gave respondents the opportunity to choose which section of the
questionnaire they wanted to complete.
Standards and Required Elements. Section two focused on the standards and required elements.
Respondents were asked to rate their level of agreement with the statement “This required
element is clear and easy to interpret” for each required element within each standard using a fivepoint agreement scale that ranged from 1, strongly disagree to 5, strongly agree. A space for
comments was included with each required element.
Competencies and Performance Indicators. In Section three, respondents were asked for input on
the competencies and performance indicators for the associate degree program. For each
competency and its associated performance indicators, respondents were asked to provide two
ratings using a five-point agreement scale (1, strongly disagree to 5, strongly agree). Ratings were
provided for the statements “This competency and its performance indicators are clear” and “This
competency is important for future practice in nutrition and dietetics”. A space for comments was
included for each competency.
Section four and five were similar to section three. Section four asked for input on the
competencies and performance indicators for the bachelor degree program and section five
requested input on the competencies and performance indicators for the master degree program.
The same two rating scales that were used for the associate degree program competencies and
performance indicators were used for the bachelor and master degree competencies and
performance indicators. A space for comments was included for each competency.
General Comments. Section six provided comment boxes for general input on the associate,
bachelor and master degree standards, competencies and performance indicators. A general
comment box also was provided.
146
RESULTS
A total of 1,250 individuals responded to the online public comment survey (Table 29).
Additionally, nine organizations/groups [Nutrition and Dietetics Educators and Practitioners;
Council on Future Practice; Nutrition Informatics Committee (NIC); Interoperability and Standards
Committee (ISC); Nutrition Services Payment Committee; School Nutrition Services DPG; Consumer
Protection and Licensure Subcommittee; Veteran’s Administration administrators; internship
directors, nutrition and dietetics educators offering an alternate model; Association of Nutrition
Departments and Programs] provided written comments on behalf of their organization/group.
Input Related to Standards and Required Elements
A portion (13%) of survey respondents chose to provide in depth input on the standards and
required elements (Table 30). These respondents provided ratings on the clarity and ease of
interpreting each standard and its required elements and gave written comments for potential
ways to improve the required elements. As shown in Table 31, most of the required elements
were rated 3.75 or higher on the five-point scale suggesting that the required element was clear
and easy to interpret. Table 32 includes the ACEND decisions related to the required elements with
lower ratings and/or with multiple comments addressing the same concern.
Input Related to Competencies and Performance Indicators
Several individuals chose to provide in depth input on the competencies and performance
indicators for the associate, bachelor and master degree programs (Table 33). These respondents
provided ratings on the clarity and importance for future practice of each competency and its
performance indicators and gave written comments for potential ways to improve them.
Associate Degree. The roles of those who chose to provide in depth input on the competencies
and performance indicators for the associate degree program are in Table 33. As shown in Table
34, all of the competencies and performance indicators were rated 3.5 or higher on the five-point
scales suggesting that the associate degree competencies and performance indicators were clear
and were important for future practice. Table 35 includes ACEND decisions related to the
competencies and performance indicators with lower ratings and/or with multiple comments
addressing the same concern.
Bachelor Degree. A number of individuals chose to provide in depth input on the competencies
and performance indicators for the bachelor degree program (Table 33). Table 36 includes ratings
for the competencies and performance indicators; all were rated 3.5 or higher on the five-point
scales suggesting that the bachelor degree competencies and performance indicators were clear
and were important for future practice.
Analysis of variance was used to explore whether ratings differed based on the role of the
respondent (e.g. program directors, practitioners) providing the rating. Several differences were
found and are noted in Table 36. For differences found in the clarity ratings, preceptors,
practitioners and employers indicated more agreement that the competencies and performance
indicators were clear than did program directors and faculty. For differences found in the
importance to future practice ratings, practitioners and employers indicated more agreement that
the competencies were important to future practice than did program directors and faculty.
147
Table 37 includes ACEND decisions related to the competencies and performance indicators with
lower ratings and/or with multiple comments addressing the same concern.
Master Degree. Many individuals chose to provide in depth input on the competencies and
performance indicators for the master degree program (Table 33). As shown in Table 38, all of the
competencies and performance indicators were rated 3.5 or higher on the five-point scales
suggesting that the master degree competencies and performance indicators were clear and were
important for future practice.
Analysis of variance was used to explore whether ratings differed based on the role of the
individual (e.g. program directors, practitioners) providing the rating. Very few differences were
found.
Table 39 includes ACEND decisions related to the competencies and performance indicators with
lower ratings and/or with multiple comments addressing the same concern.
General Comments Related to the Future Education Model Standards
Many of the respondents in the public comment survey (55%) chose to make their comments in
the general comments section of the survey. Some organizations submitted written letters with
their comments. Several themes, which were not specific to the standards or competencies
emerged. Table 40 includes ACEND decisions related to those themes that reflected multiple
comments.
148
Table 29. Individuals providing public comments
Role
n
%
Practitioners
532
43.9
Program Directors
229
18.9
Preceptors
115
9.5
Program Faculty Members
101
8.3
Students/Interns
97
8.0
Professionals in Other Disciplines
38
3.1
Employers
37
3.0
62
5.1
Other
a
a
Other includes former program directors, retired faculty and practitioners
Table 30. Individuals providing in depth input on the future education model standards
Role
n
a
%
Program Directors
61
37.0
Practitioners
45
27.3
Preceptors
14
8.5
Program Faculty Members
13
7.9
Employers
7
5.5
Professionals Outside Nutrition and Dietetics
6
3.6
Othera
20
10.2
Other includes former program directors, students, retired faculty and practitioners
149
Table 31. Ratings for Future Education Model Required Elements
Standard/Required Elements
n
Claritya
Mean ± SD
% Agree/
Strongly Agree
Standard 1. Program Characteristics and Resources
1.1 Program location
166
3.89±1.39
77%
1.2 Organization culture
162
3.75±1.42
71%
1.3 Program setting
159
4.20±1.03
85%
1.4 Program resources
155
4.06±1.10
81%
1.5 Degree/verification awarded
155
3.83±1.39
73%
1.6 Program director required credentials
153
3.27±1.57
56%
1.6 Program director responsibilities
142
4.10±1.08
85%
1.7 Program length
143
3.17±1.51
52%
Standard 2. Program Mission, Goals and Objectives
2.1 Mission
126
3.60±1.31
65%
2.2 Goals
125
4.18±0.99
86%
2.3 Program objectives
125
4.11±1.06
86%
2.4 Program required objectives
128
3.91±1.14
76%
Standard 3. Program Evaluation and Improvement
3.1 Program evaluation plan
124
4.16±0.88
84%
3.2 Evaluation evidence
121
4.11±0.90
84%
3.3 Use of plan
122
4.22±0.74
86%
Standard 4. Curriculum and Learning Activities
4.1 Curriculum map
121
3.78±1.24
71%
4.2 Learning activities
118
3.39±1.48
60%
Standard 5. Competency Assessment and Curriculum
Improvement
5.1 Competency assessment plan
120
3.83±1.06
74%
5.2 Curriculum review
119
4.00±1.02
80%
Standard 6. Faculty and Preceptors
6.1 Number of faculty and preceptors
113
4.16±1.00
83%
6.2 Faculty and preceptor requirements
119
3.37±1.39
58%
6.3 Orientation and training
117
3.76±1.25
73%
Standard 7. Supervised Learning Experience Sites
7.1 Site requirements
115
3.91±1.14
73%
Standard 8. Information to Prospective Students and the
Public
8.1 Compliance with regulations
116
4.24±1.00
85%
8.2 Source of information
115
4.30±0.85
89%
8.3 Required program information
116
4.19±0.96
84%
Standard 9. Policies and Procedures
9.1 Program operations policies
111
3.94±1.18
76%
9.2 Program policies (a – j)
110
4.14±0.84
84%
9.2 Program policies (k – t)
108
4.22±0.77
85%
a
Scale: Required element is clear and easy to interpret. 1, strongly disagree to 5, strongly agree
150
Table 32. Public comments related to required elements and ACEND decision
Required Element
Examples of Comments
ACEND Decision
1.1 Program location
Consortium implies one under another
Use term “partnership”;
defined in RE
Define what is meant by consortium or partnership
1.2 Organization
Structure
Concern if this means the institution providing the
experiential learning needs to be incorporated as part of
the organizational structure of a university
Deleted; covered in RE 1.1
Is this needed – covered in RE 1.1
1.3 Program Setting
Unclear what is meant by this RE – more clarity needed
Eliminated RE 1.3
The RE seem unnecessary – covered in other REs
Not clear how this would this be measured
1.4 Program
resources
Clarify what is meant by this; very wordy
1.5 Degree/
verification awarded
What is purpose of verification statement for associate
degree
Why is “scholarship and service” included; the mission of
the program is to educate students; scholarship and
service are the institution not program responsibility
Change language to be similar to 2017 to allow for
individuals coming into the program with a degree
already
1.6 Program director
requirements &
responsibilities
Director of master program does not need to have a
doctorate – use same language as faculty
1.7 Program length
Hours required for bachelor degree are too high
Hours required for bachelor are not high enough
Amount of time allowed for alternate experiences
should be less
Hours required for master degree are not high enough
Since standards are designed to be competency based;
let program determine what is needed to meet the
competencies
Learning activities for bachelors should not be same as
master; if bachelor doing “less complex” should all
disease states be included
4.2 Learning
activities
Performance indicators should not need to be included
on the syllabi
Include intellectually and developmentally disabled as
one of the conditions
6.2 Faculty and
preceptor
requirements
Reworded for clarity
Faculty in master program should not need a doctorate
degree; should say graduate degree
Faculty in associate and bachelor program should not
need a master degree
151
Verification statement
removed from RE 1.5 for
associate degree; bachelor
and master changed to
language in 2017 Standards
Degree and experience
requirements for director of
master degree program
changed
Specified hours of
supervised learning
experience removed; will
assess in demonstration
programs
Performance indicators
removed as a requirement
on syllabi; learning activities
rewritten to better clarify
difference in bachelor and
master degree
Degree requirements for
faculty changed
Table 33. Individuals providing in depth input on the future education model competencies and
performance indicators
Role
a
Associate
Bachelor
Master
n
%
n
%
n
%
Program Directors
9
30.0
23
22.5
30
34.5
Practitioners
8
26.7
45
44.1
20
23.0
Preceptors
1
3.3
5
4.9
8
9.2
Program Faculty Members
2
6.7
8
7.8
10
11.5
Employers
4
13.3
5
4.9
4
4.6
Othera
6
20.0
16
15.7
15
17.2
Other includes former program directors, students, retired faculty and practitioners
152
Table 34. Ratings for Associate Degree Competencies and Performance indicators
Competency
Unit 1 Foundational Knowledge
1.1 Demonstrates an understanding of the principles of food
and nutrition.
1.2 Integrates knowledge of determinants of health into all
aspects of nutrition care and services.
1.3 Demonstrates knowledge of wellness strategies that
contribute to long term health.
1.4 Applies principles of food safety and sanitation standards
specific to culinary skills, food supply and food storage
1.5 Demonstrates understanding of the public health system.
Unit 2: Professionalism
2.1 Demonstrates ethical behaviors becoming of a
professional.
2.2 Engages in reflective practice activities to maintain ongoing
competence and self-awareness.
2.3 Adheres to legislation, regulations, standards of practice
and organizational policies.
Unit 3: Individual and Community Services
3.1 Screens basic nutrition and health needs of individuals and
communities.
3.2 Participates in the development, monitoring and
modifications of the client/patient’s nutrition programs.
3.3 Considers the factors that impact food availability in the
community within the social determinants of health.
3.4 Supports recipe modification and meal planning based on
cultural needs and preferences in collaboration with other
professionals.
3.5 Coordinates community nutrition programs and promotes
access to community resources.
3.6 Provides nutrition information and approved evidenceinformed nutrition educational materials to meet the
needs of the individual and community.
Unit 4: Cultural Competence
4.1 Demonstrates an understanding of the principles of
cultural competence.
4.2 Identifies and addresses cultural needs of the individual
and community.
4.3 Demonstrates knowledge of foods, cultural and religious
food traditions, eating patterns and trends in the
community.
a
Scale: “This competency and its performance indicators are clear”
b
a
Importance to
Future
Practiceb
n
Clarity
28
3.57±1.29
3.50±1.55
27
3.56±1.34
3.63±1.36
27
3.59±1.37
3.65±1.32
26
4.15±0.73
4.04±0.93
27
3.85±1.13
3.78±1.19
26
4.00±1.20
4.12±0.99
26
3.69±1.38
3.88±1.13
26
4.04±1.04
4.04±0.96
26
3.73±1.25
3.72±1.34
25
3.72±1.34
3.64±1.38
26
4.04±1.04
4.04±0.96
24
4.08±0.93
3.83±1.27
24
3.71±1.19
3.79±1.10
24
3.67±1.24
3.71±1.12
24
3.71±1.27
4.13±0.79
24
3.83±1.24
4.00±1.02
22
3.73±1.32
3.82±1.18
1, strongly disagree to 5, strongly agree
Scale: “This competency is important for future practice in nutrition and dietetics” 1, strongly disagree to
5, strongly agree
153
Table 34. cont.
Unit 5: Communication, Collaboration and Advocacy
5.1 Applies effective written and oral communication skills and
techniques to achieve desired goals and outcomes.
5.2 Works collaboratively with intraprofessional and
interprofessional team members, individuals and the
community.
5.3 Advocates for nutrition programs and services for
individuals and the community.
154
21
3.90±1.04
3.95±1.16
21
3.95±1.16
4.00±1.09
21
3.67±1.15
3.71±1.01
Table 35. Public comments related to associate degree competencies and performance indicators
and ACEND decision
Competency/Performance Indicator
PI 1.1.4 Investigates and suggests
improvements to basic nutritional risk
management plans
Examples of Comments
ACEND Decision
“Investigates” too high a level verb
C 1.3. Demonstrates knowledge of
wellness strategies that contribute to
long term health
Per Physical Activity Guidelines for
Americans change “exercise” to
‘physical activity”
Changed to: Identifies
common risks and suggests
improvements to basic
nutritional risk
management plans
Changed “exercise” to
“physical activity”
throughout; changed from
“client/patient” to
“individual” throughout;
deleted 1.3.5 and 1.3.6
Question whether the practitioner
works with “clients/patients” or
“individuals”
PI 2.3.1 Understands governance of
nutrition and dietetics such as
legislative scope of nutrition and
dietetics practice and the Code of
Ethics for the nutrition and dietetics
profession
Awkward wording; can it be stated
more clearly
Changed to: Understands
legislative scope of practice
and the professional ethics
for nutrition and dietetics
practitioners.
C 5.1 Applies effective written and
oral communication skills and
techniques
Many of the performance indicators
seem duplicative; can some be
eliminated
Eliminated PI 5.1.1, 5.1.6,
5.1.8, 5.1.9, 5.1.10
155
Table 36. Ratings for Bachelor Degree Competencies
Competency
n
Clarity
a
Mean±SD
Importance to
Future Practiceb
Mean±SD
Unit 1 Foundational Knowledge
1.1 Applies a basic understanding of environmental and genetic
102
4.19±1.02
4.47±0.87
factors and food in the development and management of disease.
1.2 Demonstrates an understanding of anatomy and physiology.
100
4.31±1.09
4.52±0.79
1.3 Demonstrates an understanding of microbiology related to food
97
4.28±1.02
4.47±0.76
and nutrition and food safety.
1.4 Demonstrates knowledge of chemistry and food science as it
97
4.15±1.18
4.30±0.98
pertains to food and nutrition.
1.5 Demonstrates and applies knowledge of patho-physiology and
96
4.35±1.08
4.49±0.97
biochemical functionality and their relationship to physiology.
1.6 Applies knowledge of social, psychological and environmental
98
4.32±1.05
4.48±0.87
aspects of eating and food.
1.7 Applies the principles of cultural competence within own practice.
98
4.31±0.98
4.52±0.86
1.8 Demonstrates basic knowledge of pharmacology and integrative
97
4.08±1.24
4.33±1.06
and functional nutrition.
1.9 Demonstrates knowledge of math and statistics.
97
4.18±0.99
4.24±0.90
1.10 Demonstrates knowledge of medical terminology when
95
4.35±0.99
4.46±0.88
communicating with individuals.
1.11 Demonstrates knowledge of food preparation techniques.
96
4.35±0.98
4.46±0.88
1.12 Applies nutrition informatics in the decision making process.
95
4.14±1.11
4.30±1.01
1.13 Applies nutrition knowledge in the provision of nutrition care at all
97
4.33±0.95
4.56±0.75
stages of the life cycle.
1.14 Applies knowledge of nutritional health promotion and disease
98
4.28±1.01
4.52±0.79
prevention for individuals and groups.
Unit 2: Client/Patient Services
2.1 Applies a framework to assess, develop, implement and evaluate
87
4.28±0.99*
4.39±0.91
nutritional program and services directed to clients/patients
whose nutritional health needs are less complex.
2.2 Conducts and interprets nutrition screening using standardized
85
4.34±0.92
4.48±0.77
tools for individuals, groups or targeted populations whose
nutritional health needs are less complex.
2.3 Utilizes the nutrition care process to manage clients/patients with
88
3.76±1.36
4.25±1.22
less complex nutritional health needs when practice setting
environmental supports are in place.
2.4 Performs nutritional interventions for client/patient with less
79
4.05±1.30*
4.22±1.28*
complex nutrition care needs when environmental supports are in
place.
2.5 Considers the client/patient’s use of integrative and functional
80
4.09±1.15*
4.19±1.20*
nutrition and related beliefs and values.
a
Scale: “This competency and its performance indicators are clear” 1, strongly disagree to 5, strongly agree
b
Scale: “This competency is important for future practice in nutrition and dietetics” 1, strongly disagree to
5, strongly agree
* p<.05; analysis of variance of ratings based on group responding (i.e. program directors, practitioners)
156
Table 36 cont.
Competency
Clarity
Importance to
Future Practice
Mean±SD
Mean±SD
77
4.25±0.92
4.19±1.10
77
4.30±0.81
4.13±1.14
77
4.32±0.89
4.3±0.94
75
4.05±1.05
3.99±1.10
76
4.39±0.71
4.18±1.02
74
73
74
4.18±1.02*
4.18±1.11*
4.24±0.99*
4.41±0.81
4.21±1.11*
4.28±1.01*
73
4.27±0.96*
4.27±0.99*
73
4.14±1.03*
3.97±1.19*
74
73
4.28±1.00*
4.30±0.97*
4.46±0.83*
4.44±0.77
74
4.38±0.85*
4.53±0.73*
74
4.42±0.96
4.59±0.74*
73
4.40±0.88
4.47±0.85
74
4.46±0.83
4.51±0.76
74
4.45±0.81
4.55±0.68
73
4.22±1.00*
4.33±0.97*
74
4.26±0.86
4.23±0.91
n
Unit 3: Food Systems Management
3.1 Manages the production, distribution and service of
quantity and quality of food products.
3.2 Coordinates the purchasing, receipt and storage of food
products and services.
3.3 Applies principles of food safety and sanitation to the
production and service of food.
3.4 Applies an understanding of agricultural practices and
processes.
Unit 4: Community and Population Health Nutrition
4.1 Works collaboratively with others to assesses, implement
and evaluate community and population based programs.
Unit 5: Leadership, Business, Management and Organization
5.1 Demonstrates leadership skills to guide practice.
5.2 Applies principles of organization management.
5.3 Applies project management principles to achieve project
goals and objectives.
5.4 Incorporates quality improvement into nutrition and
dietetic practice.
5.5 Incorporates risk management strategies into practice.
Unit 6: Critical Thinking, Research and Evidence-Informed
Practice
6.1 Incorporates critical thinking skills in overall practice.
6.2 Identifies and understands the scientific method and
research ethics.
6.3 Applies current research and evidence-informed practice
to services.
Unit 7: Professionalism
7.1 Demonstrates ethical behaviors in accordance to the
professional Code of Ethics.
7.2 Engages in self-reflective practice to maintain ongoing
competence and professional behaviors.
7.3 Adheres to nutrition related legislation, regulations and
standards of practice.
Unit 8: Communication, Collaboration and Advocacy
8.1 Applies effective and ethical communication skills and
techniques to achieve desired goals and outcomes.
8.2 Works with and facilitates intraprofessional and
interprofessional collaboration and teamwork.
8.3 Demonstrates advocacy skills to promote awareness and
required change.
157
Table 37. Public comments related to bachelor degree competencies and performance indicators
and ACEND decision
Competency/Performance
Indicator
C 1.1 Applies basic understanding
of environmental and genetic
factors and food in the
development and management
of disease
Examples of Comments
ACEND Decision
Term “genetic” is not broad enough
to reflect current practice
Changed to: Applies a basic
understanding of environmental
and molecular factors (e.g. genes,
proteins, metabolites) and food in
the development and management
of disease.
C 1.8 Demonstrates basic
knowledge of pharmacology and
integrative and functional
nutrition
Concepts of pharmacology and
integrative and functional nutrition
should be separated
Created two new competencies and
modified performance indicators.
C 1.8 Demonstrates knowledge of
food and drug interactions
C 1.9 Demonstrates basic
knowledge of complementary and
integrative nutrition
Use NIH term “complementary and
integrative nutrition”
Ensure that integrative and
functional nutrition is evidencebased
Too high a level for bachelor level
C 2.3 Utilizes the nutrition care
process to manage
clients/patients with less
complex nutritional health needs
when practice setting
environmental supports are in
place
C 2.4 Performs nutritional
interventions for client/patient
with less complex nutrition care
needs when environmental
supports are in place
C 2.5 Considers client/patent’s
use of integrative and functional
nutrition and related beliefs and
values
Too high level for bachelor prepared;
overlaps with master
Better differentiate role of bachelor
and master prepared practitioners
Concern for licensure and scope of
practice
Not clear what is meant by
“environmental supports”
Major revision to clarify and
differentiate bachelor and master
graduates. C 2.3, 2.4, and 2.5
deleted; new competencies written
(C 2,3 – C 2.5) and environmental
supports defined (C 2.3):
C 2.3 Conducts a nutrition
assessment on individuals with less
complex or less acute nutritional
health care needs when
environmental supports (e.g.
policies, procedures, validated
tools, administration, credentialed
staff such as registered dietitian
nutritionists) are in place
C 2.4 Creates PES (problem,
etiology and sign or symptom)
statement for less complex, less
acute nutritional health care needs
when environmental supports are
in place to inform the plan of care.
C 2.5 Recommends and implements
interventions in collaboration with
the client/patient and other team
members, when environmental
supports are in place
C 2.6 Monitors and evaluates the
impact of the intervention
158
Table 37. cont.
Competency/Performance
Indicator
Examples of Comments
ACEND Decision
C 5.1 Applies leadership skills to
guide practice
Too high a level for bachelor degree
Changed wording to: Demonstrates
leadership skills
C 5.2 Applies principles of
organization management
Intent of competency not clear
Competency Unit 7
Professionalism Behaviors and
Unit 8 Communication,
Collaboration and Advocacy
Is all the detail in the performance
indicators needed; much of this
seems like common sense
General Comments
Too many competencies and
performance indicators.
Changed wording to: Applies
organization management to direct
staff and support department
operations
Combined competency units 7 and
8 into a new unit 7 Core
Professional Behaviors with two
competencies: C 7.1 Assumes
professional responsibilities to
provide safe, ethical and effective
nutrition services and C 7.2 Uses
effective communication,
collaboration and advocacy skills
Number of competencies reduced
from 38 to 36 and performance
indicators reduced from 216 to 166
159
Table 38. Ratings for Master Degree Competencies
Competency
n
Clarity
a
Mean±SD
Importance to
Future
Practiceb
Mean±SD
Unit 1 Foundational Knowledge
1.1 Applies an understanding of environmental and genetic factors
88
3.85±1.20
4.06±1.12
and food in the development and management of disease.
1.2 Applies an understanding of anatomy and physiology.
85
4.26±1.09
4.34±1.08
1.3 Applies knowledge of microbiology and food safety.
85
3.91±1.23
4.17±1.11
1.4 Integrates knowledge of chemistry and food science as it pertains 83
3.89±1.23
4.08±1.16
to food and nutrition product development and when making
modifications to food.
1.5 Demonstrates and applies knowledge of patho-physiology and
84
4.14±1.12
4.43±1.00
biochemical functionality and their relationship to physiology,
health and disease.
1.6 Applies knowledge of social, psychological and environmental
83
3.92±1.20
4.15±1.11
aspects of eating and food.
1.7 Integrates the principles of cultural competence within own
83
4.07±1.10
4.24±1.07
practice and when directing services.
1.8 Applies knowledge of pharmacology and integrative and
83
3.73±1.28
4.19±1.11
functional nutrition to recommend, prescribe and administer
medical nutrition therapy.
1.9 Applies knowledge of math and statistics.
83
4.01±1.13
4.02±1.16
1.10 Applies knowledge of medical terminology when communicating
79
4.23±1.05
4.30±1.04
with individuals, groups and other health professionals.
1.11 Demonstrates knowledge of food preparation techniques.
81
3.98±1.21
4.06±1.13
1.12 Applies nutrition informatics in the decision making process.
81 3.75±1.17*
4.11±1.01
1.13 Integrates knowledge of nutrition and physical activity in the
81
4.19±1.03
4.29±.99
provision of nutrition care at all stages of the life cycle.
1.14 Applies knowledge of nutritional health promotion and disease
83
3.99±1.21
4.35±1.03
prevention for individuals, groups and populations.
1.15 Gains a foundational knowledge on global health issues and
82
3.84±1.12
3.94±1.13
nutritional needs.
Unit 2: Client/Patient Services
2.1 Uses a framework to assess, develop, implement and evaluate
73
3.77±1.18
4.14±1.04
products, programs and services.
2.2 Selects, develops or implements nutritional status screening tools 72
4.03±1.15
4.25±1.10
for individuals, groups or populations.
2.3 Utilizes the nutrition care process with individuals, groups or
72
4.10±1.19
4.44±1.05
populations in a variety of practice settings.
2.4 Performs or coordinates nutritional interventions for individuals,
74
3.85±1.32
4.30±1.08
groups or populations.
2.5 Prescribes or recommends nutrition-related pharmacotherapy
70
3.63±1.41
3.86±1.33
and integrative and functional nutrition.
a
Scale: “This competency and its performance indicators are clear” 1, strongly disagree to 5, strongly agree
b
Scale: “This competency is important for future practice in nutrition and dietetics” 1, strongly disagree to
5, strongly agree
* p<.05; analysis of variance of ratings based on group responding (i.e. program directors, practitioners)
160
Table 38. cont.
Competency
n
Clarity
Mean±SD
Importance to
Future
Practice
Mean±SD
Unit 3: Food Systems Management
3.1 Oversees the production and distribution of quantity and
quality food products.
3.2 Oversees the purchasing, receipt and storage of products used
in food production and services.
3.3 Applies principles of food safety and sanitation to the
production and service of food.
3.4 Applies and demonstrates an understanding of agricultural
practices and processes.
Unit 4: Community and Population Health Nutrition
4.1 Follows programming planning steps to develop and implement
community, population and global programs.
4.2 Identifies environmental and public health hazards that impact
nutrition and participates in or coordinates the management of
the situation.
4.3 Engages in legislative and regulatory activities that address
community, population and global nutrition health and
nutrition policy.
Unit 5: Leadership, Business, Management and Organization
5.1 Demonstrates leadership skills to guide practice.
5.2 Applies principles of organization management.
5.3 Applies project management principles to achieve project goals
and objectives.
5.4 Leads quality improvement activities to measure evaluate and
improve a program services products and initiatives.
5.5 Develops and implements risk management strategies and
programs.
Unit 6: Critical Thinking, Research and Evidence-Informed Practice
6.1 Incorporates critical thinking skills in managing complex
situations.
6.2 Applies scientific methods utilizing ethical research practices
when reviewing, evaluating and conducting research.
6.3 Applies current research and evidence-informed practice to
services.
Unit 7: Professionalism
7.1 Demonstrates ethical behaviors in accordance to the
professional Code of Ethics.
7.2 Engages in self-reflective practice activities to develop and
demonstrate social and emotional intelligence to maintain
ongoing competence and professional behaviors.
7.3 Adheres to nutrition related legislation, regulations and
standards of practice.
161
73
3.97±1.13
3.95±1.20
72
3.97±1.05
3.70±1.28
73
3.86±1.18
3.83±1.24
71
3.88±1.16
3.72±1.27
71
3.94±1.23
4.04±1.13
69
3.86±1.27
3.90±1.21
70
3.66±1.38
3.74±1.31
69
71
70
3.86±1.29
3.80±1.40
4.01±1.23
4.10±1.15
3.93±1.32
3.93±1.22
71
4.00±1.29
4.11±1.19
70
3.74±1.30
3.68±1.30
70
3.94±1.35
4.11±1.30
71
4.27±1.06
4.25±1.11
71
4.31±1.12
4.45±1.05
71
4.30±.98
4.38±1.03
69
4.10±1.09
4.22±1.06
71
4.30±1.01
4.42±.94
Table 38. cont.
Unit 8: Communication, Collaboration and Advocacy
8.1 Applies effective and ethical communication skills and
techniques to achieve desired goals and outcomes.
8.2 Works with and facilitates intraprofessional and
interprofessional collaboration and teamwork.
8.3 Demonstrates advocacy skills to promote awareness and
required change.
162
72
4.04±1.30
4.18±1.25
71
3.97±1.40
4.14±1.28
71
3.86±1.42
3.72±1.46
Table 39. Public comments related to master degree competencies and performance indicators
and ACEND decision
Competency/Performance
Indicator
C 1.1 Applies an understanding of
environmental and genetic
factors and food in the
development and management
of disease
Examples of Comments
ACEND Decision
Term “genetic” is not broad enough
to reflect current practice
Changed to: Applies an
understanding of environmental
and molecular factors (e.g. genes,
proteins, metabolites) and food in
the development and management
of disease.
C 1.8 Applies knowledge of
pharmacology and integrative
and functional nutrition to
recommend, prescribe and
administer medical nutrition
therapy
Concepts of pharmacology and
integrative and function nutrition
should be separated
Created two new competencies and
modified performance indicators.
C 1.8 Applies knowledge of
pharmacology to recommend,
prescribe and administer medical
nutrition therapy
C 1.9 Applies an understanding of
complementary and integrative
nutrition on drugs, disease, health
and wellness
C 2.5 Prescribes or recommends
nutrition-related
pharmacotherapy and integrative
and function nutrition
Too high level for entry-level master
prepared
C 3.1 Oversees the production
and distribution of quantity and
quality food products
“oversees” seems too low of a verb
level
Wording changed to: Directs the
production and distribution of
quantity and quality of food
products
C 4.2 Identifies environmental
and public health hazards that
impact nutrition and participate
in or coordinates the
management of the situation
Too high level for entry-level master
prepared
C 4.2 and its performance
indicators deleted
Competency Unit 7
Professionalism Behaviors and
Unit 8 Communication,
Collaboration and Advocacy
Is all the detail in the performance
indicators needed; much of this
seems like common sense
General Comments
Too many competencies and
performance indicators.
Use NIH term “complementary and
integrative nutrition”
Ensure that integrative and function
nutrition is evidence-based
Much of the Integrative and function
nutrition is not evidence-based; not
sure dietitian should be prescribing
this
Integrative and function nutrition
removed from this competency;
Revised wording: Prescribes,
recommends and administers
nutrition-related pharmacotherapy.
Practice sites will not allow students
to do this
163
Combined competency units 7 and
8 into a new unit 7 Core
Professional Behaviors with two
competencies: C 7.1 Assumes
professional responsibilities to
provide safe, ethical and effective
nutrition services and C 7.2 Uses
effective communication,
collaboration and advocacy skills
Number of competencies reduced
from 41 to 37 and performance
indicators reduced from 274 to 218
Table 40. Public comments related to Future Education Model Standards and ACEND decision
Competency/Performance
Indicator
Examples of Comments
ACEND Decision
Degree for entry-level Registered
Dietitian Nutritionist (RDN)
Degree should be master degree as
proposed
Continue with development of
master degree standards with
competencies designed for added
skills needed in future practice;
evaluate outcomes in the
demonstration programs
Degree should be bachelor level
using current education model (CP,
DPD, DI); master degree should be
advanced practice
Degree should be practice doctorate
Degree for entry-level Nutrition
and Dietetics Technician,
Registered (NDTR)
Degree should be bachelor degree as
proposed
Degree should be associate level
using current education model
Universities will not support a
bachelor degree program that
prepares “technicians”
Associate degree for Nutrition
Health Worker
This new degree/position should be
implemented as proposed
This option should be eliminated,
there are not positions for this
proposed associate degree
practitioner
Change the title, term “worker” is
demeaning
Prerequisite requirement for
master degree
Generalist vs specialist for master
degree
Program should be given flexibility to
set the prerequisites for their
program
The bachelor degree should be a
required prerequisite for the master
degree
Master degree should have
designated specialist focus;
foodservice, clinical, community
Programs should be able to
determine whether to have focus
area
Share raw data
All raw data should be shared
164
Continue with development of
bachelor degree standards with
competencies designed to elevate
practice; evaluate outcomes in the
demonstration programs; rename
the graduate a Food and Nutrition
Practitioner
Continue with development of
associate degree standards with
competencies designed to prepare
a community support practitioner;
evaluate outcomes in the
demonstration programs; rename
the graduate a Nutrition Health
Associate
Continue to allow master degree
programs the flexibility to establish
their own pre-requisite
requirements; evaluate in the
demonstration programs
Establish the core competencies for
the master degree program;
programs will retain the flexibility
to choose whether to offer
specialty tracks/concentrations;
evaluate in the demonstration
programs
To follow common research
practice, reduce confirmation bias,
and protect confidentiality, ACEND
has data analyzed and releases a
summary of input received
REFERENCES
1. Nyland N, Lafferty L. Implications of the dietetics workforce demand study. J Acad
Nutr Diet. 2012;112:(Suppl 1):S92-S94.
2. Rhea M, Bettles C. Future changes driving dietetics workforce supply and demand: future
scan 2012- 2022. J Acad Nutr Diet. 2012;112(Suppl 1):S10-S24.
3. Hooker RS, Williams JA, Papneja J, Sen N, Hogan P. Dietetics supply and demand: 20102020. J Acad Nutr Diet. 2012;112(Suppl 1):S75-S91.
4. Ward B, Rogers D, Mueller C, Touger-Decker R, Sauer K. Entry level dietetics practice
today: results from the 2010 Commission on Dietetic Registration Entry-Level Practice
Audit. J Am Diet Assoc. 2011;111(6):914-941.
5. Sauer KL, Rogers D. Results of the 2013 non-RD bachelor’s-DPD graduate dietetics practice
audit. J Am Diet Assoc. 2014;114(10):1630-1639.
6. Academy of Nutrition and Dietetics. Final report of the joint meeting of the Council for
Education in Nutrition and Dietetics, Commission on Dietetic Registration, Council on
Future Practice, Education Committee, Nutrition and Dietetic Educators and Preceptors
DPG. Commission on Dietetics Registration website.
http://cdrnet.org/vault/2459/web/files/JointMeetingReport.pdf. Published March 25,
2013. Accessed July 25, 2014.
7. Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice
Subcommittee of the Quality Management Committee. Academy of Nutrition and Dietetics:
scope of practice for the registered dietitian. J Acad Nutr Diet. 2013;113(6, Suppl 2):S17S28.
8. Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice
Subcommittee of the Quality Management Committee. Academy of Nutrition and Dietetics:
scope of practice for the dietetics technician, registered. J Acad Nutr Diet. 2013;113(6,
Suppl 2):S46-S55.
9. Federation of State Medical Boards. Assessing scope of practice in health care delivery:
critical questions in assuring public access and safety.
http://library.fsmb.org/pdf/2005_grpol_scope_of_practice.pdf. Published 2005.
Accessed July 25, 2014.
10. Academy of Nutrition and Dietetics. Standards of professional performance for registered
dietitian nutritionists (competent, proficient and expert) in sustainable, resilient and
healthy food and water systems. J Acad Nutr Diet. 2014;114(3):475-488.
11. LeFevre ML, The U.S. Preventive Services Task Force. Behavioral counseling to promote a
healthful diet and physical activity for cardiovascular disease prevention in adults with
cardiovascular risk factors: U.S. preventive services task force recommendation
statement. Ann Intern Med. 2014:161(8):587-93.
12. Fitzgerald N, Morgan KT, Slawson DL. Practice paper of the Academy of Nutrition and
Dietetics abstract: the role of nutrition in health promotion and chronic disease
prevention. J Acad Nutr Diet. 2013;113(7):983. doi:10.1016/j.jand.2013.05.007.
13. Slawson DL, Fitzgerald N, Morgan KT. Position of the Academy of Nutrition and Dietetics:
the role of nutrition in health promotion and chronic disease prevention. J Acad Nutr Diet.
2013;113(7):972- 979. doi:10.1016/j.jand.2013.05.005.
14. Olstad DL, Raine KD, McCargar LJ. The role of registered dietitians in health promotion.
165
Can J Diet Pract Res. 2013;74(2):80-83. PMID: 23750980.
15. Institute of Medicine. Center for Health Workforce Studies. Allied Health Workshop,
Institute of Medicine: May 9 and 10, 2011, Scope of Practice and the Future of Team
Based Care. https://www.health.ny.gov/health_care/medicaid/redesign/docs/2011-1003_chws_presentation.pdf Accessed September 11, 2014.
16. Federal Register. Medicare and Medicaid programs; regulatory provisions to promote
program efficiency, transparency and burden reduction; part II.
https://www.federalregister.gov/articles/2014/05/12/2014-10687/medicare-andmedicaid- programs-regulatory-provisions-to-promoteprogram-efficiency-transparencyand. Published May 12, 2014. Accessed August 27, 2014.
17. Martin AL, Lipman RD. The future of diabetes education: expanded opportunities and
roles for diabetes educators. Diabetes Educ. 2013;39(4):436-446.
18. The College of Dietitians of Ontario and Dietitians of Canada. Application for review of the
scope of practice of dietetics in Ontario submitted to the Health Professions Regulatory
Advisory Council. Dietitians of Canada website. http://www.dietitians.ca/DownloadableContent/Public/scope-of- practice-survey-Ontario-2008.aspx. Published June 30, 2008.
Accessed September 11, 2014.
19. Institute of Medicine. America’s Health Care Safety Net: Intact but Endangered.
Washington, DC: National Academy Press; 2000.
20. Institute of Medicine. Rebuilding the Unity of Health in the Environment: A New Vision of
Environmental Health for the 21st Century. Workshop Summary. Washington, DC: National
Academy Press; 2001.
21. Institute of Medicine. Health Professions Education – A Bridge to Quality.
Washington, DC: National Academy Press; 2003.
22. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st
Century. Washington, DC: National Academy Press; 2001.
23. Institute of Medicine. Global Forum on Innovation in Health Professional Education.
http://www.iom.edu/Activities/Global/InnovationHealthProfEducation.aspx. Accessed
November 16, 2014.
24. Institute of Medicine. Interprofessional Education for Collaboration: Learning How to
Improve Health from Interprofessional Models across the Continuum of Education to
Practice – Workshop Summary. Washington, DC: National Academy Press; 2012.
25. Institute of Medicine. Establishing Transdisciplinary Professionalism for Improving Health
Outcomes - Workshop Summary. Washington, DC: National Academy Press; 2012.
26. Interprofessional Education Collaborative Expert Panel. Core Competencies for
Interprofessional Collaborative Practice: Report of an Expert Panel. Washington, DC:
Interprofessional Education Collaborative; 2011.
27. Institute of Medicine. Interprofessional Education for Collaboration: Learning How to
Improve Health from Interprofessional Models across the Continuum of Education to
Practice: Workshop Summary. Washington, DC: The National Academies Press; 2013.
166
28. World Health Organization. Framework for action on interprofessional education and
collaborative practice.
http://www.who.int/hrh/resources/framework_action/en/index.html. Published 2010.
Accessed September 11, 2014.
29. Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming
education to strengthen health systems in an interdependent world. Lancet.
2010;376(9756): 1923-1958.
30. Institute of Medicine. Complementary and Alternative Medicine in the United States.
Washington, DC: The National Academies Press; 2005.
31. Bravewell Collaborative. Elements of integrative care.
http://www.bravewell.org/integrative_medicine/integrative_care/. Accessed August
15, 2014.
32. Consortium of Academic Health Centers for Integrative Medicine. 2005. Definition of
integrative medicine. http://www.imconsortium.org/cahcim/about/home.html.
Accessed August 15, 2014.
33. Kreitzer MJ, Kligler B, Meeker WC. Health professions education and integrative health
care.
http://www.iom.edu/~/media/Files/Activity%20Files/Quality/IntegrativeMed/Health%20Pr
ofession s%20Education%20and%20Integrative%20HealthCare.pdf. Accessed August 15,
2014.
34. Institute of Medicine, National Research Council. Investing in the Health and Well-being
of Young Adults. Washington, DC: The National Academies Press; 2014.
35. Adelman C, Ewell P, Gaston P, Schneider CG. The Degree Qualifications Profile. Lumina
Foundation for Education: Indianapolis, IN: 2011.
36. Coppard BM, Dickerson A; Commission on Education. A descriptive review of occupational
therapy education. Am J Occup Ther. 2007;61(6):672-677.
37. American Physical Therapy Association. Designation “PT,” “PTA,” “SPT,” AND “SPTA” HOD
P06-03- 17-14.
http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/HOD/Terminology/Design
ation.pdf. Updated December 14, 2009. Accessed, July 2, 2014.
38. Physician Assistant Education Association. PA Clinical Doctorate Summit final report and
summary. http://www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/78715.
Published April 15, 2009. Accessed July 2, 2014.
39. Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for
the professional program in pharmacy leading to the doctor of pharmacy degree.
https://www.acpe- accredit.org/standards/. Accessed, July 2, 2014.
40. Boyleston ES, Collins MA. Advancing our profession: are higher educational standards the
answer? J Dent Hyg. 2012;86(3):168-178.
41. Holmes DE, ed. From Education to Regulation: Dynamic Challenges for the Health Workforce.
Association of Academic Health Centers: Washington, DC: 2008.
42. Siler W, Randolph DA. Clinical look at clinical doctorates. Chron Rev. 2006:52(46):B12.
167
43. US Department of Health and Human Services. HHS strategic plan and secretary's
strategic initiatives. http://www.hhs.gov/strategic-plan/priorities.html. Reviewed July
29, 2014. Accessed September 15, 2014.
44. Cooperative Extension’s National Framework for Health and Wellness.
March 2014. https://www.aplu.org/document.doc?id=5134 Accessed
November 16, 2014.
45. National Prevention Council. National Prevention Strategy. US Department of Health and
Human Services, Office of the Surgeon General: Washington, DC; 2011.
46. The Benefits Improvement and Protection Act of 2000. Pub L No. 106-554, 2000.
47. Nutrition therapy services (medical) Medicare.gov
http://www.medicare.gov/coverage/nutrition- therapy-services.html Accessed October
7, 2014.
48. Academy of Nutrition and Dietetics. CMS final rule on therapeutic diet orders
means new opportunities for RDNs. J Acad Nutr Diet. 2014;114(9):1326-1328.
49. Roberts SR. Improving patient outcomes through registered dietitian order writing. Nutr Clin
Pract. 2013;28(5):556-65. doi: 10.1177/0884533613499375.
50. Imfeld K, Keith M, Stoyanoff L, Fletcher H, Miles S, McLaughlin J. Diet order entry by
registered dietitians results in a reduction in error rates and time delays compared
with other health professionals. J Acad Nutr Diet. 2012;112(10):1656-1661. doi:
10.1016/j.jand.2012.05.020.
51. Medicare.gov. About Physician Compare.
http://www.medicare.gov/physiciancompare/staticpages/aboutphysiciancompare/abo
ut.html. Accessed October 7, 2014.
52. Academy of Nutrition and Dietetics. Nutrition services delivery and payment: the business of
every Academy member: House of Delegates Fact Sheet. Public Health/Community
Nutrition dietetics practice group website.
http://www.phcnpg.org/docs/Governance/HOD%202013/HOD-Fact-Sheet- Outcomes-ofFall-HOD-Meeting-FINAL-11-21-13.pdf. Published Fall 2013. Accessed October 7, 2014.
53. Bardach NS, Wang JJ, De Leon SF, Shih SC, Boscardin WJ. Effect of pay-for-performance
incentives on quality of care in small practices with electronic health records: A randomized
trial. JAMA. 2013;310(10):1051-1059. doi:10.1001/jama.2013.277353.
54. Rosen R, Earthman C, Marquart L, Reicks M. Continuing education needs of registered
dietitians regarding nutrigenomics. J Acad Nutr Diet. 2006;106(8):1242-1245.
55. Whelan K, McCarthy S, Pufulete M. Genetics and diet-gene interactions: involvement,
confidence and knowledge of dietitians. Br J Nutr. 2008;99(1):23-28.
56. McCarthy S, Pufulete M, Whelan K. Factors associated with knowledge of genetics and
nutritional genomics among dietitians. J Hum Nutr Diet. 2008;21(6):547-554.
57. Camp KM, Trujillo E. Position of the Academy of Nutrition and Dietetics: nutritional
genomics. J Acad Nutr Diet. 2014;114(2):299-312.
58. Vickery CE, Cotugna N. Incorporating human genetics into dietetics curricula remains a
challenge. J Acad Nutr Diet. 2005;105(4):583-588.
168
59. Gregg S, Cohen D, Cerami J, Conn CA, The role of the registered dietitian in the patientcentered medical home. Top Clin Nutr. 2014;29(3):201-209.
60. Fuhrman MP, Galvin TA, Ireton-Jones CS, Thorpe J; American Dietetic Association. Practice
paper of the American Dietetic Association: Homecare--opportunities for food and nutrition
professionals. J Am Diet Assoc. 2009;109(6):1092-1100. PMID: 19480085.
61. Sahyoun NR. Expanding opportunities for registered dietitians in the healthcare system. J
Am Diet Assoc. 2011;111(6):813-815. doi: 10.1016/j.jada.2011.03.024. PMID: 21616192.
62. Rogers D. Dietetics trends as reflected in various primary research projects, 1995-2011. J
Acad Nutr Diet. 2012;112(Suppl 1):S64-S74.
63. Gilbride JA, Parks SC, Dowling R. The potential of nutrition and dietetics practice. Top Clin
Nutr. 2013;28(3):209-219.
64. Ayres EJ, Greer-Carney JL, McShane PE, Miller A, Turner P. Nutrition informatics
competencies across all levels of practice: A national Delphi study. J Acad Nutr Diet.
2012;112(12):2042-2053.
65. Institute of Medicine. The Role of Telehealth in an Evolving Health Care Environment:
Workshop Summary. Washington, DC: The National Academies Press; 2012.
66. Health Resources and Services Administration, US Department of Health and Human
Services. Telehealth.
http://www.hrsa.gov/healthit/toolbox/RuralHealthITtoolbox/Telehealth/index.html.
Accessed November 12, 2014.
67. Siminerio S, Ruppert K, Huber K, Toledo FG. Telemedicine for Reach, Education, Access and
Treatment (TREAT): linking telemedicine with diabetes self-management education to
improve care in rural communities. Diabetes Educ. 2014;40(6):797-805. doi:
10.1177/0145721714551993.
68. Chapter 12 of the “Medicare Claims Processing Manual” (Publication 100-04) located at
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-OnlyManuals-IOMs- Items/CMS018912.html. Accessed September 20, 2014.
69. Chapter 15 of the “Medicare Benefit Policy Manual” (Publication 100-02) located at
http://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/downloads/clm104c12.pdf. Accessed September 20,
2014.
70. Gilman M, Stensland J. Telehealth and medicare: payment policy, current use and
prospects for growth. Medicare Medicaid Res Rev. 2013;3(4):E1-E14. doi:
10.5600/mmrr.003.04.a04.
71. Soderquist C, Overakker S. Education for sustainable development: a systems thinking
approach. Global Environ Res. 2010;14:193-202.
72. Thornton B, Peltier G, Perreault G. Systems thinking: a skill to improve student
achievement. The Clearing House. 2004;77(5):222-227.
73. Academy of Nutrition and Dietetics. Business and management skills: HOD backgrounder.
California Dietetic Association website.
http://www.dietitian.org/d_orange/materials/sep2014_mtg/Business_and_Management_S
kills_Bac kgrounder.pdf. Published Fall, 2014. Accessed December 21, 2014.
169
74. Academy of Nutrition and Dietetics Compensation and Benefits Survey 2013: education
and job responsibility key to increased compensation. J Acad Nutr Diet.
2014;114(1):17-33.
75. Academy of Nutrition and Dietetics. Management and leadership across practice: HOD
backgrounder.
http://www.eatright.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=6442481596&libI
D=64424 81573. Published February 2010. Accessed December 20, 2014.
76. Karp SS, Lawrence ML. Uses of new competencies to assess entry-level dietitians. J Am Diet
Assoc.1999;99(9):1098-1100.
77. Canter DD. Management Is a multifaceted component essential to the skill set of successful
dietetics practitioners. J Acad Nutr Diet. 2012;112:(Suppl 1):S5.
78. Gould RA, Canter D. Management matters. J Am Diet Assoc. 2008;108(11):1834-1836.
79. Puckett RP, Barkley W, Dixon G, et al. American Dietetic Association standards of
professional performance for registered dietitians (generalist and advanced) in
management of food and nutrition systems. J Am Diet Assoc. 2009;109(3):540543.e13.
80. Gregoire MB, Sames K, Dowling RA, Lafferty LJ. Are registered dietitians adequately
prepared to be hospital foodservice directors? J Am Diet Assoc. 2005;105(8):1215-1221.
81. Cluskey M, Gerald B, Gregoire M. Management in dietetics: are we prepared for the
future? J Am Diet Assoc. 2007;107(3):386-389.
82. Puckett RP, Barkley W, Dixon G, Egan K, Koch C, Malone T, Scott-Smith J, Sheridan B,
Theis. American Dietetic Association Standards of Professional Performance for
registered dietitians (generalist and advanced) in management of food and nutrition
systems. J Am Diet Assoc. 2009;109(3):540-543.
83. O’Sullivan Maillet J, Brody RA, Skipper A, Pavlinac JM. Framework for analyzing supply and
demand for specialist and advanced practice registered dietitians. J Acad Nutr Diet.
2012;112(Suppl 1):S47- S55.
84. Gregoire MB, Arendt SW. Leadership: reflections over the past 100 years. J Acad Nutr Diet.
2014;114(Suppl 1):S10-S19.
85. Institute of Medicine. Integrating research and practice: Health system leaders working
toward high- value care: Workshop summary. Washington, DC: The National Academies
Press; 2014.
86. Boyce B. Learning to lead: developing dietetics leaders. J Acad Nutr Diet. 2014;114(5):688692.
87. Wolf AM, Conaway MR, Crowther JQ, et al. Translating lifestyle intervention to practice in
obese patients with type 2 diabetes: Improving Control with Activity and Nutrition (ICAN)
study. Diabetes Care. 2004;27(7):1570-1576.
88. Wolf AM, Siadaty M, Yaeger B, et al. Effects of lifestyle intervention on health care costs:
Improving Control with Activity and Nutrition (ICAN). J Am Diet Assoc. 2007;107(8):13651373.
89. Parrott JS, White JV, Schofield M, et al. Current coding practices and patterns of code use
of registered dietitian nutritionists: the Academy of Nutrition and Dietetics 2013 coding
survey. J Acad Nutr Diet. 2014;114(10):1619-1629.
170
90. Center for Medicare and Medicaid Services. Physician Quality Reporting System (PQRS)
overview. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Downloads/PQRS_OverviewFactSheet_2013_08_06.pdf. Accessed
October 13, 2014.
91. Greiner A. Educating Health Professionals to Use an Evidence Base. Current Reality,
Barriers and Related Actions. Washington, DC: National Academy Press; 2001.
92. Sackett D, Rosenberg W, Gray M, Haynes B, Richardson S. Evidence-based medicine: what
it is and what it isn’t. BMJ. 1996;312:71-72.
93. Haynes EB, Devereaux PJ, GuyatT GH. Clinical expertise in the era of evidence-based
medicine and patient choice. Evid Based Med. 2002;7:36-38.
94. Lusardi MM, Levangie PK, Fein BD. A problem-based learning approach to facilitate
evidence-based practice in entry-level health professional education. J Prosthet Orthot.
2002;14(2):40-50.
95. Vogt EAM, Byham-Gray LD, Touger-Decker R. Perceptions, attitudes knowledge and clinical
use of evidence-based practice among U.S. registered dietitians: A prospective descriptive
pilot study. Top Clin Nutr. 2013;28(3):283-294.
96. Institute of Medicine. Roundtable on value and science-driven health care.
http://www.iom.edu/Activities/Quality/VSRT.aspx. Accessed September
11, 2014.
97. Byham-Gray LD, Gilbride JA, Dixon LB, Stage FK. Predictors for research involvement
among registered dietitians. J Am Diet Assoc. 2006;106(12):2008-2015.
98. Anchondo IM, Campbell C, Zoellner J. Academy of Nutrition and Dietetics 2011 survey on
member research activities, needs and perceptions. J Acad Nutr Diet. 2014;114(5):803810.
99. Gardner JK, Rall LC, Peterson CA. Lack of multidisciplinary collaboration is a barrier to
outcomes research. J Am Diet Assoc. 2002;102(1):65-71.
100. King C, Byham-Gray L, O’Sullivan Maillet J, Parrott S, Splett JP, Roberts MM. Dietitians
and research: facilitating involvement: history of dietitian involvement in dietetics
research in the U.S. Top Clin Nutr. 2014;29(3):227-238. doi:
10.1097/TIN.0000000000000002.
101. Eck LH, Slawson DL, Williams R, Smith K, Harmon-Clayton K, Oliver D. A model for
making outcomes research standard practice in clinical dietetics. J Am Diet Assoc.
1998;98(4):451-457.
102. Sears B, Ricordi C. Anti-inflammatory nutrition as a pharmacological approach to treat
obesity. J Obesity. 2011. doi:10.1155/2011/431985.
103. Academy of Nutrition and Dietetics. Position of the American Dietetic Association:
integration of medical nutrition therapy and pharmacotherapy. J Acad Nutr Diet.
2010;110(6):950-956.
104. Rossi T, Gallo C, Bassani B, Canali S, Albini A, Bruno A. Drink your prevention:
beverages with cancer preventive phytochemicals. Pol Arch Med Wewn.
2014;124(12):713-722.
105. Rich E, Lipson D, Libersky J, Parchman M. Coordinating care for adults with complex care
needs in the patient-centered medical home: challenges and solutions. AHRQ Publication
No. 12-0010-EF. Rockville, MD: Agency for Healthcare Research and Quality; January 2012.
171
106. Jaarsma T. Inter-professional team approach to patients with heart failure. Heart
2005;91(6):832-838. doi: 10.1136/hrt.2003.025296.
107. SEO Economic Research. Cost-benefit analysis of dietary treatment.
http://www.seo.nl/uploads/media/2012-76a_Costbenefit_analysis_of_dietary_treatment.pdf. Published November 2013. Accessed
September 11, 2014.
108. Davis AM, Affenito SG. Nutrition and public health: preparing registered dietitian
nutritionists for marketplace demands. J Acad Nutr Diet. 2014;114(3):695-699.
109. Kicklighter JR, Cluskey MM, Hunter AM, Nyland NK, Spear BA. Council on future practice
visioning report and consensus agreement for moving forward the continuum of dietetics
education, credentialing and practice. J Acad Nutr Diet. 2013;113(12):1710-1732.
110. Academy of Nutrition and Dietetics. Academy of Nutrition and Dietetics registered
dietitian brand evaluation research results. J Acad Nutr Diet. 2014;114(10):1640-1646.
111. Yannicelli S, Davis A; Research Dietetics Practice Group of the Academy of Nutrition and
Dietetics. Conducting Clinical Trials in the Nutrition Industry: We’re Not in Academics
Anymore! The Digest. 2010;45(2):1-8.
172