New innovations in the development of practice placement education for student dietitians
The education and training of dietitians, as with all health care practitioners, emphasises the development of clinical skills. These practical skills are considered key to professional competence. It is widely accepted that appropriate placement experience is considered the most effective method to develop the professional skills necessary to practice and succeed as a professional (Fry, Ketteridge and Marshall 1999) and, therefore, programmes of undergraduate study include practice placement modules which enable students to develop their practical skills and competence in a workplace environment before graduation (Mulholland et al. 2006). For trainee health professionals, this is typically in a clinical environment.
While the competences required to enter the profession are well described (INDI 2008; EFAD 2009), evidence for the best way for students to acquire the skills required and how this should be assessed in a progressive way is lacking.
Assessing clinical skill acquisition and level of competence is difficult for clinicians in all health professions including nursing, medicine and the professions allied to medicine (including dietetics). Despite the number of assessment methods described in the literature (see Hanley and Higgins 2005; Makoul 2001; Norman et al. 2002; Pender and de Loy 2004; Spalding 2000), providing fair and objective assessment and feedback that is appropriate for the stage of training that the student has reached, and that indicates a progression in development is challenging for most practice placement educators regardless of their level of training or experience. Assessment that promotes superficial learning is of little benefit and incompatible with the type of learning that takes place in the work environment. A number of different methods are required, most of which are formative in nature and which should include an element of self-assessment. Further to this, the curriculum of practice placement is often likened to that of a spiral, i.e. ‘there is an iterative revisiting of topics, subjects or themes throughout the course’ (Harden and Stamper 1999: 141). The experiential learning cycle and the spiral curriculum both place a lot of emphasis on the ability of the student to be able to reflect both on and in practice.
The UK Learning and Teaching Support Network (LTSN) Generic Centre in 2001 explained how formative assessment provides a framework for sharing educational objectives with students and its usefulness in charting students’ progress was described in Juwah et al. 2004. Formative assessment generates feedback which can be used by the student to enhance learning and by teachers to realign their teaching in response to their learners’ needs. The LTSN asserts that ‘formative assessment should be an integral part of teaching and learning in higher education’. It seems logical therefore, that formative assessment should be an integral component of the assessment of practice placement.
Much of the literature from medicine, nursing, dietetics and other health professions supports the use of direct observation as the preferred method for assessing clinical skills (see Battles et al. 1992; Dolan 2003; Norman et al. 2002; Pender and de Loy 2004; Williams, Klamen and McGahie 2003). However, criticism of direct observation is evident in the literature due mainly to the level of subjectivity involved (see Dolan 2003; Williams, Klamen and McGahie 2003). Despite this, direct observation remains the most popular method of assessment in the practice placement setting across the health professions with skilled observers considered as having the ability to make judgements on clinical performance. However, it is recommended that this is used in combination with other forms of assessment, e.g. reflective journals, written work, objective structured exams.