William D. Evers

Computer-Assisted Instruction Improves Clinical Reasoning Skills of Dietetics Students

OBJECTIVE The effects of a computer-assisted instruction (CAI) tutorial program on learning clinical reasoning skills were compared in undergraduate dietetics students. DESIGN A drill-and-practice program to control for time on task, and tutorial program, and a simulation program, as the test vehicle, were developed. The tutorial and simulation programs presented data on a patient with cardiovascular disease. SETTING Subjects were tested in 30 undergraduate dietetics programs. SUBJECTS Participants were 413 undergraduate diet therapy students enrolled in a coordinated program in dietetics (CPD) or a didactic program in dietetics (DPD). INTERVENTION After completion of lectures on cardiovascular disease, subjects were given the drill-and-practice program plus a simulation test (group 1), the tutorial plus a simulation test (group 2), or the simulation test only (group 3). MAIN OUTCOME MEASURES Scores on the simulation test were compared. Variables included type of CAI, dietetics program, year in school, computer experience, and experience using a medical chart. Mastery of objectives related to lower- and higher-level clinical reasoning skills introduced in the tutorial program was computed. STATISTICAL ANALYSIS One-way analysis of variance and Student-Newman Keuls tests were conducted to determine any differences among the three groups. Reliability was determined using the Kuder-Richardson Formula 20. RESULTS The reliability coefficient of the stimulation test was 0.93. Group 2 higher on the simulation test than group 1 or group 3. As a group, the CPD students scored higher than the DPD students. When CPD and DPD students were divided into the three experimental groups, there was no significant difference between the CPD and DPD student simulation scores. Group 2 mastered all objectives for lower-level reasoning skills and the higher-level decision-making objective better than groups 1 and 3. APPLICATIONS/CONCLUSIONS A computer tutorial program enhanced clinical reasoning skills in undergraduate dietetics students. This type of program could be used to supplement many topics taught in diet therapy and provide DPD students with experimental learning before their clinical intern practicums.

Computer-Based Simulations Enhance Clinical Experience of Dietetics Interns

OBJECTIVE To determine the impact of computer-based simulations on the performance of dietetics interns in initial clinical rotations. DESIGN Interns used either a simulation program (Care Planning Simulation System CPSS[) or a computer-based tutorial (Nutrition Care Planning Tutorial NCPT[) during their orientation. Performance of these interns on nutrition care skills was evaluated during their initial clinical rotations. SUBJECTS/SETTING Participants were 108 dietetics interns from 8 different programs. Each internship had at least 8 interns, and none of the internships awarded a graduate degree. INTERVENTION Subjects in the experimental group completed nutrition assessment and care planning activities for 3 simulated patients. Subjects in the control group completed a tutorial on assessment and care planning. MAIN OUTCOME MEASURES Likert scale ratings of 31 behaviors were recorded by clinical preceptors. Behavior statements were grouped into 8 categories and average ratings for each category were determined. STATISTICAL ANALYSIS Repeated-measures analysis of variance and linear regression were used to compare performance ratings between groups. RESULTS There were no differences in overall evaluations of the simulation and tutorial groups for the 8-week period. Interns who started clinical rotations immediately after orientation (CPSS-I and NCPT-I groups) were rated lower in all categories than those who began their clinical rotations later (CPSS-D and NCPT-D groups). Maturation and acquisition of general skills likely influenced ratings of interns with delayed clinical rotations. For most categories of behavior the rate of improvement in rating scores was greatest for interns who used CPSS. APPLICATIONS Computer-based simulations are a promising supplement to current techniques in didactic instruction and may be useful in both didactic and practice settings. Computer-based simulations can provide more varied practice experiences to didactic students and interns in preparation for more skilled entry-level positions in dietetics.

Dietetics Students' Ability to Choose Appropriate Communication and Counseling Methods Is Improved by Teaching Behavior-Change Strategies in Computer-Assisted Instruction

Several models and theories have been proposed to help registered dietitians (RD) counsel and communicate nutrition information to patients. However, there is little time for students or interns to observe and/or participate in counseling sessions. Computer-assisted instruction (CAI) can be used to give students more opportunity to observe the various methods and theories of counseling. This study used CAI simulations of RD-client communications to examine whether students who worked through the CAI modules would choose more appropriate counseling methods. Modules were created based on information from experienced RD. They contained videos of RD-patient interactions and demonstrated helpful and less helpful methods of communication. Students in didactic programs in dietetics accessed the modules via the Internet. The intervention group of students received a pretest module, two tutorial modules, and a posttest module. The control group only received the pretest and posttest modules. Data were collected during three semesters in 2006 and 2007. Two sample t tests were used to compare pretest and posttest scores. The influence of other factors was measured using factorial analysis of variance. Statistical significance was set at P<0.05. Eleven didactic programs participated. A total of 350 students were in the intervention group and 102 students were in the control group. Pretest scores were not different (6.30+/-0.26 vs 6.21+/-0.15, control and intervention, respectively). The intervention groups posttest score was higher than its pretest score (6.21+/-0.15 vs 6.65+/-0.16, pretest and posttest, respectively). Change in score from pretest to posttest was higher for the intervention group (-0.02+/-0.20 vs 0.44+/-0.11, control and intervention, respectively). For the 21 questions in the tutorials, those who answered 19 to 21 correctly had a greater increase from pretest to posttest than those who answered <13 correctly (-0.44+/-0.37 vs 0.84+/-0.17, <13 and 19 to 21 correct, respectively). There was no effect of instructor, grade point average, school year, or prior counseling on the results. The study provides evidence that the use of CAI can improve communication and counseling methods for dietetics students.

Dietetic Interns Using Computer Simulations Model Care Planning Strategies of Registered Dietitians

Abstract Fifty-five dietetic interns from eight different programs used three computer-based simulations of patients with cardiovascular disease during the orientation phase of the internship. Users were asked to assess each patient and develop a nutrition care plan. The simulations included a medical record and other information typically available for a newly hospitalized patient. A main menu of eight choices was available at the start of the simulation, and could be accessed from any point in the program. These choices were: A. Visit patient, B. Visit at mealtime, C. Review chart, D. Calculate kcal/protein needs, E. See patients menu, F. Review nutrition screening, G. Prepare care plan, and H. Finished with assessment. Users could move freely through the simulation, viewing data in each section as desired. Upon completion of the nutrition care plan to the users satisfaction, a series of feedback screens was shown. These screens showed the nutrition-related problems identified by the user, and the pathway (sequence of choices) used to complete the care plan. In addition, feedback informed the user of how a panel of experienced dietitians had approached care planning with this patient. At the end of the feedback section, users continued with the next simulation. Menu choices of dietetic interns were rank-ordered and compared across simulations using Friedmans chi-square test. The choice of F (Review Screening) was progressively earlier (2.8 for simulation 1, 1.6 for simulation 2, and 1.4 for simulation 3, p

Computer-Based Clinical Simulations Enhance Care Planning Skills of Dietetic Interns

Abstract A computer-based simulation system (CPSS) was developed to include three realistic scenarios of patients with cardiovascular disease. Beginning dietetic interns used either these simulations or an alternative computer tutorial (NCPT) during their internship orientation. During the subsequent eight weeks of clinical rotations, interns were evaluated weekly by their clinical preceptors. Performance ratings were collected using a 31-item rating form and a five-point Likert scale (1=Unacceptable performance, 5=Outstanding performance). Four categories of behaviors represented the nutrition care planning process: A=Obtaining Data; B=Interviewing Client; C=Analyzing Data; D=Developing Plan. Over the eight weeks of evaluation, linear regression analysis revealed a faster rate of improvement (p

Fingerprinting Hunger Relief Efforts in Indiana, Wisconsin, and Iowa

Abstract More than 12% of the US population suffers from hunger. Not-for-profit food distribution organizations, including food banks, food pantries, soup kitchens, emergency shelters, and other food programs, help provide for the nutritional needs of more than 25 million Americans each year. Because many states do not require licensing or registration, it is difficult to accurately determine the number or types of food assistance programs operating throughout the country. The purpose of this project was to develop a directory and database of not-for-profit food distribution organizations operating in Indiana, Iowa, and Wisconsin. An initial listing of food distribution organizations was obtained from the Division of Family and Children in each state. These lists were then expanded with the aid of food bank member agency lists, input from Cooperative Extension field staff in each county, and a variety of other sources. The resulting master list consisted of nearly 2,500 organizations in the 3 states (Indiana - 1,200, Wisconsin - 800, Iowa - 500). A survey was developed, piloted, and mailed to each of the 2,500 identified organizations. A follow-up post card was mailed 6 weeks later. Surveys were returned at a rate of about 30%. A database was constructed to provide access to the survey data. Organizational, operational, and educational needs information was entered for each responding organization. The names and addresses of nonrespondents were also entered into the database. The database was constructed to permit searching based on a variety of criteria, including: county, city, zip code, organization name, and type of program. A directory of food assistance organizations was also constructed for each of the 3 states. Each directory lists the names and addresses for all survey nonrespondents and the name, address, and general information for all respondents who agreed to be included. The directories and database developed through this project provide a previously unavailable view of the hunger communities in a 3 state area. Additionally, these tools allow food donors to quickly locate recipient organizations, simplify cooperative efforts between organizations, and provide a quick reference for members of the hunger community.