Exploring students’ experiences of dietetic placements and their impact on self-perceived confidence. A design-based research

Abstract

Dietitians are well placed to provide healthcare to combat the rise of nutrition related-illness. It is necessary to have effective dietetic training to ensure the quality of healthcare dietitians are able to provide. Competency-based education employed in New Zealand dietetic curricula involves an outcome-focused approach to developing graduate-level competence. Clinical placements endeavour to provide students with adequate opportunities to develop dietetic competencies. They facilitate the application of theoretical knowledge, and the development of clinical, social and professional skills. Aim: The overall aim of this research is to investigate the impact the dietetic placement programme has on students’ confidence in practising competencies. This research aims to evaluate how self-rated confidence evolves throughout the dietetic programme and identify possible barriers to developing confidence. It also aims to identify how the curriculum can be improved to positively impact self-rated confidence. Methods: Participants are dietetics students at the University of Auckland. The study consists of two main phases as a mixed methods approach, involving the cyclical distribution of questionnaire surveys and focus group discussions. The survey assesses self-rated confidence via a 5-point Likert scale at several time points across the 2-year degree. It consists of 44 questions separated into 5 domains of practice; clinical competence, communication, responsiveness to Māori, cultural competence/safety and professionalism. Students who have completed all placements participated in focus group discussions about their experience of the placement programme and its influence on their perceived confidence and competence. Results: Overall, self-rated confidence improved over time across all five domains, most notably in the latter stage of the curriculum. Measuring and managing expectations, experiential learning, navigating hospital administrative and social environments, and cultural self-reflection were the main themes to arise. Barriers of perceived confidence and competence include comparison to peers, engaging with supervisors, lack of experiential learning and lack of opportunity for reflective self-evaluation. Conclusion: The research conducted in this thesis has the potential for future application within dietetic curricula across universities to evaluate changes in confidence and competence across multiple cohorts and inform improvements to the dietetic workforce.