Incorporating the Nutrition Care Process model into dietetics internship evaluation: A Malaysian university experience

Aim

Implementation of the Nutrition Care Process (NCP) into dietetics curricula and clinical internship evaluation in Asian countries is new. Two dietetics faculties from Malaysia and USA collaborated to assimilate NCP into clinical dietetics curriculum and internship evaluation.

Methods

Dietetic interns under supervised practice in hospitals were assessed using a quantitative NCP-based evaluation tool. This tool organised learning outcomes under NCP knowledge domains and achieved high internal consistency and inter-rater reliability. Using a 5-point Likert scale, interns' scores measured over a 12-week inpatients training were collated and analysed. Subgroup analysis differentiated strong (Progressers) and weak (Regressers) performers based on a median criterion of averaged NCP component scores.

Results

Most external hospital sites (75% response rate) utilised the evaluation tool for interns' assessment. Improvements in NCP knowledge domains were significant by week-9 and week-12 compared to baseline (P<0.001). Largest gain was associated with Step 2, nutrition diagnosis (95% CI: 2.63–3.09 vs 3.44–3.81, = 0.297) and ADIME (nutrition Assessment, Diagnosis, Implementation, Monitoring and Evaluation) documentation (95% CI: 2.85–3.22 vs 3.72–4.15, = 0.339). A median score of 3.5 at week-12 identified 'Progressers' (>3.5) or 'Regressers' (<3.5). Progressers demonstrated increasing linear trends from baseline to week-12 (P < 0.001 for all components) with change for ADIME documentation (95% CI: 4.07–4.49, = 0.456) > Step 2, nutrition diagnosis (95% CI: 3.70–4.12, = 0.348) > Step 3, nutrition intervention (95% CI: 3.65–3.96, = 0.332) > Step 1, nutrition assessment (95% CI: 3.77–4.09, = 0.307) > Step 4, monitoring and evaluation (95% CI: 3.72–4.04, = 0.269). Weaker interns achieved maximum scores at week-9 before regressing.

Conclusions

This study found that the application of an NCP-based evaluation tool successfully tracked interns' clinical competencies under supervised practice.

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