Dietetics Education and Training

The following quotation from the introduction of The Manual of Dietetic Practice (Thomas, 2001) summarizes some of the skills needed by a dietitian—all of which must be acquired during preregis-tration and continuing professional development. The emphasis here is on the role of the clinical dietitian; additional skills will be acquired by the dietitian working in public health and policy:

While principles of care can be standardised, the way in which they are applied has to vary to take account of individual needs, problems, lifestyle, associated health risks, and readiness to change. In order to provide effective care the modern dietitian has to exercise considerable clinical judgement in deciding how a specific set of circumstances may be most appropriately managed. This requires more than just nutritional knowledge. The modern-day dietitian has to make a global risk assessment when setting nutritional goals, have an understanding of human behaviour in order to achieve dietary change, acquire the interviewing and counselling skills necessary for meaningful dialogue between patient and professional, and have the ability to evaluate whether objectives have been achieved.

It is now therefore accepted that the practice of dietetics requires a wide range of knowledge and skills that are achieved by both academic study and practice learning. As the scope of dietetic practice has expanded over the years, the preregistration education and training programs have continually adapted to ensure that the practitioner has the current knowledge and skills required. The education and training of a dietitian usually comprises a degree program (either BSc or MSc), based in a university, including or followed by a period of practical training (or internship) based in recognized hospital dietetic departments.

Preregistration programs include coverage of basic and applied sciences (chemistry, biochemistry, physiology, nutrition, and microbiology) as well as social sciences (psychology and sociology). In addition, because dietetics is concerned with feeding people, a knowledge of the food habits of populations together with detailed knowledge of food composition and food preparation is essential. To this basic foundation is added knowledge of medicine, pathology, and the therapeutic uses of dietary treatment and, increasingly emphasized, the development of skills required to communicate with all types of people whether counselling individuals or teaching groups.

During the practical training or internship, the student dietitian learns to apply the theory learned at university with individuals or groups of people. The training covers all aspects of dietetic practice and the students spend time in different settings, including community care and, in some countries, large-scale catering establishments. In order to become a registered practitioner, the students must demonstrate that they have both good theoretical knowledge and are competent practically.

In the United States, United Kingdom, Canada, Australia, New Zealand, South Africa, The Netherlands, and many other countries training programs are regulated by bodies external to the educational establishments and successful completion of such a regulated training allows registration as a dietitian. In the United States, regulation of courses and training programs is carried out by the ADA and in the United Kingdom by the Health Professions's Council (HPC), in conjunction with the Quality Assurance Agency of the Higher Education Funding Council. In the United Kingdom, only registered dietitians may be employed in the National Health Service. The registration body, in each case, produces a statement of conduct that describes the role and responsibilities of the registered dietitian, and failure to work within this statement of conduct may result in disciplinary action and removal from the register. In the United Kingdom, since 2003 this code of conduct has been presented as 'standards of proficiency' and on registration the registered dietitian must sign a document that involves taking responsibility to work only in areas in which he or she is competent to practice.

Registration in one country does not automatically mean that a dietitian can work elsewhere in the world because levels of education and training are not always comparable from country to country. Within Europe, for example, the education level and skills of dietitians vary widely and there is currently a move within the European Federation of Dietitians to develop benchmarks for dietetic qualifications. The registering body will therefore consider applications from dietitians from other countries and suggest further training if appropriate.

Continuing education and demonstration of continuing competence to practice are increasingly being seen as vital in this rapidly changing profession; in the United States there has long been a requirement to demonstrate continuing education, and continuing registration is dependent on this. In the United Kingdom, it will soon become a requirement to demonstrate continued competence to practice for continued registration with the HPC. The BDA, the professional association for dietitians, has well-developed systems for assisting dietitians in both accessing and recording continuous professional development. The provision of validated specialist courses, the development of a Diploma in Advanced Dietetic Practice, which recognizes CPD over a 5-year period, and most recently the support for a Masters Course in Advanced Dietetic Practice are examples of this. In Australia, continuing professional development is recognized by the status of Accredited Practising Dietitian.

See also: Arthritis. Burns Patients. Children:

Nutritional Requirements; Nutritional Problems. Celiac Disease. Colon: Nutritional Management of Disorders. Cystic Fibrosis. Diabetes Mellitus: Dietary Management. Food Allergies: Diagnosis and Management. Gall Bladder Disorders. Gout. Handicap: Down's Syndrome. Hyperlipidemia: Nutritional Management. Hypertension: Nutritional Management. Inborn Errors of Metabolism: Classification and Biochemical Aspects; Nutritional Management of Phenylketonuria. Infection: Nutritional Management in Adults. Low Birthweight and Preterm Infants: Nutritional Management. Obesity: Prevention; Treatment. Older People: Nutritional Management of Geriatric Patients. Stroke, Nutritional Management. Surgery: Long-term Nutritional Management.

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