UBC Dietetics Program FORUM FOR ENHANCED EDUCATION DISCUSSION

UBC Dietetics Program FORUM FOR ENHANCED EDUCATION & DISCUSSION NUTRITION CARE(FEED): SESSION DECEMBER 6 TH 2018 To join the teleconference: From the Vancouver area, call 604 -899 -2339 From outside Vancouver, call toll-free 1 -877 -385 -4099 After calling the number, enter the password: 6836560#

TODAY’S PLAN 1. NUTRITION CARE I, II & III MODULES 2. TEACHING & LEARNING RESOURCES 3. MINI-WORKSHOP 4. WRAP-UP 2 2

PRACTICE EDUCATION: BRIEF OVERVIEW 8 Modules Orientation (1 week) Nutrition Care I (6 weeks) Nutrition Care II (12 weeks) Nutrition Care III (3 -4 weeks) Management (8 weeks) Population and Public Health (4 weeks) Research (2 weeks) Elective (2 weeks) 3 3

NUTRITION CARE (NC) MODULES 2013 INTEGRATED COMPETENCIES FOR DIETETIC EDUCATION AND PRACTICE (ICDEP) LED TO PROGRAM CHANGES: • Terminology (i. e. , “clinical” to “nutrition care”) • New competency and performance indicator language • Decreased focus on exposure to all areas of practice; emphasis on broad skill development NUTRITION CARE COMPETENCIES: 1. 2. 3. 4. Assess nutrition-related risks and needs (14 indicators) Develop nutrition care plans (10 indicators) Manage implementation of nutrition care plans (4 indicators) Evaluate and modify nutrition care plans (4 indicators) 4 4

NUTRITION CARE (NC) MODULES ADDITIONAL COMPETENCIES 5. PROGRESS TOWARDS MANAGING A SMALL PATIENT CASELOAD 6. DESIGN ENTERAL FEEDING (8 INDICATORS) 7. DESIGN PARENTERAL FEEDING (5 INDICATORS) 8. DELIVER GROUP EDUCATION SESSIONS (COMM. & COLLABORATION) 9. DEVELOP LEARNING RESOURCES (COMM. & COLLABORATION) 10. DEVELOP EFFECTIVE PATIENT/CLIENT COUNSELING APPROACHES (COMM. & COLLABORATION) 5 5

NC MODULES: COMPETENCIES All 3 components together ensure students are ready for entry level dietetic practice. 6

MODULE FORMS & EXPECTATIONS Expectations/Roles: 1. Students manage the module forms • Module requirements section (pg 2) – a student responsibility • Student identifies learning goals and draws preceptor attention to module activities and timelines 2. Preceptors provide support and guidance • Teach student practical skills & applications of knowledge • Provide ongoing feedback to support development • Verify competence through evaluation 7 7

NC I: MODULE REQUIREMENTS See: Summary of Changes to Modules and Forms 8

NC II: MODULE REQUIREMENTS 9

NC III 6 weeks (2 placements) 12 weeks (3 -4 placements) 3 -4 weeks (1 placement) Introductory exposure to nutrition care Advanced nutrition care Clinical relief Cases in a variety of Cases that do not Management of settings, with increasing require complex & rapid patients/clients at the level complexity & pace of decision-making of an entry-level RD decision-making Focus on development of Focus on solidifying Focus on development nutrition counseling, nutrition care skills & of solid nutrition care decision-making & time- independent management process skills management sills of a caseload Caseload expectations: Caseload expectations vary 6 -10 patients/clients by area. Aim for goal 6 -10 patients/clients total st caseload by end of 1 week

WHAT YEAR 5 STUDENTS SHOULD KNOW ON DAY 1 OF PRACTICE EDUCATION ICDEP knowledge areas related to NC: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Anatomy & Physiology Biochemistry Food Health System in Canada Human Nutrition Across the Lifespan Microbiology Nutrition Assessment Nutrition Care Process & Medical Nutrition Therapy Pharmacology Population Food Systems and Food Security Communication Teaching & Learning 11 11

WHAT YEAR 5 STUDENTS SHOULD KNOW ON DAY Care 1 OFProcess PRACTICE EDUCATION Nutrition & Medical Nutrition Therapy • ETIOLOGY AND PATHOPHYSIOLOGY OF NUTRITION-RELATED DISEASES • NUTRITION-RELATED DISEASE MANAGEMENT STRATEGIES • USE OF ASSESSMENT, DIAGNOSIS, INTERVENTION, MONITORING, EVALUATION (ADIME) IN MEDICAL NUTRITION THERAPY • CALCULATION OF ENERGY AND NUTRIENT REQUIREMENTS FOR CONDITIONS/DISEASES • GOAL SETTING AND OUTCOME MEASUREMENT IN NUTRITION THERAPY • ORAL, ENTERAL, AND PARENTERAL NUTRITION SUPPORT • FEEDING ASSESSMENT, INCLUDING IDENTIFICATION OF CHEWING, SWALLOWING AND FEEDING PROBLEMS • COMPLEMENTARY AND ALTERNATIVE NUTRITION THERAPIES 12 12

WHAT YEAR 5 STUDENTS SHOULD KNOW ON DAY 1 OF PRACTICE EDUCATION Human Nutrition Across the Lifespan • INGESTION, DIGESTION, ABSORPTION, METABOLISM AND EXCRETION OF NUTRIENTS • BIOCHEMICAL UTILIZATION OF NUTRIENTS AND ENERGY • NUTRIENT AND ENERGY REQUIREMENTS • PHYSICAL ACTIVITY AND ENERGY BALANCE • NUTRITION RECOMMENDATIONS AND GUIDELINES • EFFECT OF DEFICIENCIES AND TOXICITIES OF NUTRIENTS • FOOD SOURCES OF NUTRIENTS AND DIETARY SUPPLEMENTS • ROLE OF NUTRIENTS AND OTHER FOOD COMPONENTS IN HEALTH • DIETARY PRACTICES 13 13

WHAT YEAR 5 STUDENTS SHOULD KNOW ON DAY 1 OF PRACTICE EDUCATION FOOD • Physical properties and chemical composition of food • Food preservation, storage and packaging • Role of ingredients and their interaction in food preparation • Household food preparation • Application of dietary requirements, guidelines, guidance tools to food planning • Food modification to address therapeutic, textural or other needs • Sensory evaluation of food • Religious and cultural food practices • Food labeling • Food-borne illness 14 14

WHAT YEAR 5 STUDENTS SHOULD KNOW ON DAY 1 OF PRACTICE EDUCATION Population Food Systems and Food Security • FOOD PRODUCTION, PREPARATION, PROCESSING, DISTRIBUTION AND WASTE MANAGEMENT • GLOBAL AND LOCAL FOOD SYSTEMS AND FACTORS AFFECTING THE SUPPLY OF FOOD • SUSTAINABLE FOOD PRACTICES • FOOD MARKETS AND MARKETING OF FOOD • FACTORS AFFECTING ACCESS TO FOOD • DISASTER PLANNING • FOOD CONSUMPTION PATTERNS AND TRENDS 15 15

1 6 TEACHING & LEARNING RESOURCES 1. NC I, II, AND III MODULE FORMS • Each form has a checklist section to assist preceptor and Year 5 students to plan activities to meet competencies 2. NUTRITION TRACKING FORM 3. TUBE FEEDING MODULES & SIMULATIONS (NC II ONLY) AVAILABLE AT: UBC DIETETICS PRACTICE EDUCATION WEBSITE 16

1 7 TEACHING & LEARNING RESOURCES 1. 2. 3. 4. 5. 6. 7. Setting the Stage for Success (handout, video) What Makes a Successful Preceptor (videos) Using Questions as a Teaching Strategy (video) Promoting Critical Thinking (handout) Providing Effective Feedback (handout) Student Performance Issues Flowchart (handout) Annual Preceptor Education Events (videos) Available at: UBC Dietetics Website (Preceptor tab) 17

MINI WORKSHOP: PROVIDING EFFECTIVE FEEDBACK 18

MINI WORKSHOP: PROVIDING EFFECTIVE FEEDBACK 1 MINUTE ACTIVITY WITH A PARTNER, OR ON YOUR OWN: REFLECT BACK TO A TIME WHEN YOU RECEIVED SOME CONSTRUCTIVE FEEDBACK. WHAT FACTORS DO YOU THINK INFLUENCED HOW WELL THE FEEDBACK WAS RECEIVED? 19

MINI WORKSHOP: PROVIDING EFFECTIVE FEEDBACK Environmental factors • • • How often? Where? Consider timing. Quality of Feedback Situational factors • • Content (positive vs negative) Specificity Interpersonal factors • • • Confidence Personality Learning style Communication style Culture Generational 20

MINI WORKSHOP: PROVIDING EFFECTIVE FEEDBACK 1 MINUTE ACTIVITY WITH A PARTNER, OR ON YOUR OWN: WHAT CHALLENGES HAVE YOU ENCOUNTERED WHEN PROVIDING STUDENTS WITH FEEDBACK? 21

TIPS FOR PROVIDING EFFECTIVE FEEDBACK • SET THE STAGE. DISCUSS AHEAD OF TIME HOW OFTEN AND HOW FEEDBACK WILL BE PROVIDED (IMMEDIATELY AFTER ACTIVITY, ON THE FLY, END OF THE DAY). CONSIDER INCLUDING HOW THE FEEDBACK WILL BE USE IN THE EVALUATION PROCESS. • ESTABLISH A SAFE LEARNING ENVIRONMENT. CHOOSE A PRIVATE SPACE, ONE ON ONE, AND ALLOW ADEQUATE TIME TO COMPLETE THE DISCUSSION. • Prompt student to self-assess first. How do you feel it went? If you were to do it again, what would you do the same/different? What did you learn from the session? • ASK PERMISSION BEFORE PROVIDING FEEDBACK. WOULD YOU BE OPEN TO RECEIVING SOME FEEDBACK RIGHT NOW? • BE CLEAR AND SPECIFIC. CONVEY KEY MESSAGES ONLY. AVOID GENERALIZING LANGUAGE (I. E. , ALWAYS, NEVER). FOCUS ON THE ACTION, AND NOT THE PERSON. • BE AWARE OF YOUR TONE AND BODY LANGUAGE. • ENCOURAGE STUDENT TO DEVELOP A PLAN. ASK THEM COME UP WITH STRATEGIES FOR IMPROVING PERFORMANCE. IF THE STUDENT IS UNSURE, PROVIDE GUIDANCE. • CLOSE THE FEEDBACK DISCUSSION. CONFIRM UNDERSTANDING (WHAT DO YOU THINK” OR “HOW DO YOU FEEL ABOUT. . . ”), AND NEXT STEPS. 22

RESOURCES ON PROVIDING EFFECTIVE FEEDBACK Video available at: http: //dietetics. landfood. ubc. ca/preceptors/preceptor-events/ Handout available at: http: //dieteticslandfood. sites. olt. ubc. ca/files/2016/07/Providing. Effective-Feedback-May-13 -16. pdf 23

Who to contact? For FH, Island & non-health authority sites: Program Leader, Practice Kara Vogt kara. vogt@ubc. ca 604 -827 -0762 Can help you with: • • For PHSA, PHC, VCH & NH: Program Leader, Campus Tamar Kafka tamar. kafka@ubc. ca 604 -827 -5762 Your core site coordinator (CSIC) Questions about the practice education Ideas/suggestions for the program in general Ideas/suggestions for preceptor or student supports Consultation on teaching and learning: ü Strategies to support a struggling student ü Advice on teaching strategies ü Resources for preceptors *Can also encourage your students to contact us directly for learning support and/or resources • • • Scheduling questions/issues Performance issues (e. g. concern a student will not pass) Local preceptor resources 24

REFERENCES 1. DIETITIANS OF CANADA. PRECEPTOR EDUCATION ELEARNING COURSE FOR DIETITIANS. 2018. HTTPS: //COURSES. DIETITIANS. CA/COURSE/VIEW. PHP? ID=74 2. HARDAVELLA G, AAMLI-GAAGNAT A, SAAD N, ROUSALOVA I, SRETER KB. HOW TO GIVE AND RECEIVE FEEDBACK EFFECTIVELY. 2017; 13(4): 327 -333. WILKINSON ST, COULDRY R, PHILLIPS HP, BUCK B. PRECEPTOR DEVELOPMENT: PROVIDING EFFECTIVE FEEDBACK. HOSP PHARM. 2013; 48(1): 26 -32. 25

2 6 REFERENCE SLIDES: FEEDBACK FROM STUDENTS/PRECEPTORS • Feedback collected regularly: • Modules and forms: annually (preceptors, students, coordinators) • Year 5 student satisfaction survey: annually • Preceptor satisfaction survey: every 2 years • Student and preceptor surveys: • Satisfaction measured with 5 -point Likert scales • Open-ended questions - things that work well, opportunities for improvement 26

2 7 REFERENCE SLIDES: FEEDBACK FROM STUDENTS/PRECEPTORS YEAR 5 STUDENT SURVEY 2018 • ALL YEAR 5 STUDENTS RESPOND TO SURVEY (N=33), REQUIREMENT OF PRACTICE EDUCATION GENERALLY HIGH SATISFACTION WITH NC Ø SATISFACTION WITH VARIOUS ASPECTS RANGES FROM 3. 7 TO 4. 58 Ø PREVIOUS LOW SATISFACTION WITH ACADEMIC PREPAREDNESS HAS IMPROVED FROM 2. 79 (2017) TO 3. 7 (2018) Ø LIKELY DUE TO REVISED NUTRITION CARE COURSES, FNH 470 & FNH 475 27

2 8 REFERENCE SLIDES: FEEDBACK FROM STUDENTS/PRECEPTORS YEAR 5 STUDENT SURVEY 2018 THINGS THAT WORKED WELL: • Ongoing constructive feedback with opportunities to apply learning and demonstrate growth • Progressive NC module structure (NC I, III) • Supportive preceptors who were keen to teach, allowed students to learn by doing • Exposure to a good variety of clinical areas, mix of inpatient and outpatient experiences 28

2 9 REFERENCE SLIDES: Year 5 Student Survey 2018 FEEDBACK FROM STUDENTS/PRECEPTORS Improvement Opportunities: • MODULE FORMS ARE TOO LONG • SOME STUDENTS FELT IT WASN’T FEASIBLE TO COMPLETE ALL READINGS • LEVEL OF INDEPENDENCE EXPECTED IN EACH MODULE VARIED BY PRECEPTOR • HOME ENTERAL TEACHING AND PARENTAL EXPERIENCES WERE DIFFICULT TO OBTAIN FOR SOME STUDENTS • PLACEMENTS SHOULD BE AT LEAST 3 -WEEKS LONG • DECREASE OR REALLOCATE NCII EXPECTATIONS (EDUCATION RESOURCE, ORAL PRESENTATION, GROUP EDUCATION) • LIKE THE IDEA OF HAVING THE SAME PRECEPTOR FOR A MODULE 29

3 0 REFERENCE SLIDES: FEEDBACK FROM STUDENTS/PRECEPTORS Preceptor Survey 2017 • Respondents (n=100): NC I - 22, NC II - 56, NC III - 22 • Respondents mostly satisfied with NC modules Ø Mean scores of 3. 79 to 4. 36 out of 5 Ø Majority of means over 4 • Lowest scores related to: student academic preparedness (mostly in NC I & II) Ø Anticipate low scores to improve next year with implementation of revised nutrition care courses - FNH 470 & FNH 475 30

3 1 REFERENCE SLIDES: FEEDBACK FROM STUDENTS/PRECEPTORS Preceptor Survey 2017 Things that worked well: • Module forms are an improvement from past years – e. g. placement planning checklist, performance guide; less time consuming to complete • Having a plan for readings, questions etc. for intern to complete before/during placement • 3 -week placement length is an improvement • Interns who are well-prepared, motivated and self-directed with their learning do well • Active participation in NC I sets them up well for NC II (rather than primarily observing) 31

3 2 REFERENCE SLIDES: FEEDBACK FROM STUDENTS/PRECEPTORS Preceptor Survey 2017 Improvement Opportunities: • CLEARLY COMMUNICATE EXPECTATIONS THAT INTERNS NEED TO DO SELF-DIRECTED WORK ON THEIR OWN TIME TO SUPPORT LEARNING • DIFFICULT TO MANAGE TIME AND WORKLOAD WHILE SUPPORTING AN INTERN • CLARIFY EXPECTATIONS RE CASELOAD (PARTICULARLY FOR NC III) • MORE INDEPENDENCE EARLIER IN NC MODULES TO BETTER PREPARE INTERNS FOR NC II & III, PARTICULARLY ENSURING HANDS-ON PRACTICE IN NC I 32