Curriculum Framework for the Pre-Registration Education and Training of Dietitians

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1 Curriculum Framework for the Pre-Registration Education and Training of Dietitians

2 Contents Curriculum Framework for dietetics education and training - Foreword 3 Abbreviations and acronyms 5 Aims and purpose of the framework 6 The role of professional and statutory bodies in the education and training of dietitians 7 The role and scope of practice of the dietitian 9 The BDA role in accreditation of programmes 11 BDA expectations for Education and Training Programmes Entry requirements for pre-registration programmes leading to registration Length and structure of dietetics programmes Curriculum delivery 3.1 Higher Education Institution Practical placement provision Quality Assurance 16 The Curriculum Framework 17 Introduction 17 The context of dietetic practice 18 Knowledge underpinning informed, safe and effective practice 19 Skills that are essential to underpin informed, safe and effective 33 practice of dietetics The application of practice in securing, maintaining or improving health and well being 38 Expectations of a dietitian as a registered health care professional as held by the profession, employers and the public 45 References 51 Web links 52 Appendices 53 How this document was developed 55

3 Curriculum Framework for dietetics education and training Foreword from The Chairman of the BDA It is my great privilege as Honorary Chairman of the BDA to have been involved in and to have worked with many of the profession and other partners in the production of this document. Since the HPC handed the responsibility for the curriculum over to the BDA, much work has been undertaken. This document is another step in the journey but it is a significant milestone to ensure that we as a profession continue to mature and remain fit to face the challenges of the future. Sincere thanks must go to the many people who have been involved in this. I fully endorse this document and look forward to the ongoing partnership between the BDA and those involved in pre-registration education of dietitians which is vital in continuing to keep our profession at the forefront of nutrition and dietetic practice. Pauline Douglas BDA Honorary Chairman 3

4 Foreword The curriculum framework for the Education and Training of Dietitians has been developed to describe in detail the key aspects of the knowledge, skills and attributes required by entry-level dietitians in order to ensure that new graduates are able to satisfy the Health Professions Council (HPC) Standards of Proficiency for Dietitians and are thus eligible for registration as a dietitian and work in the NHS and elsewhere. It also lays the foundation for the continuous professional development (CPD) which is essential for continuing registration with the HPC. The framework is intended to be flexible enough to allow Higher Education Institutions (HEIs) and their collaborating practitioner partners to provide programmes which are responsive to the demands of dietetic employment both within and outside the NHS, now and in the next five years. Until the advent of the HPC the detailed curriculum underpinning dietetics education and training of dietitians was regarded as the responsibility of the Dietitian s Board of the Council for Professions Supplementary to Medicine (CPSM). In 2005 the responsibility for the curriculum passed to the British Dietetic Association (BDA). At the point of transfer to the BDA the curriculum for dietetics education and training was described in the joint BDA/CPSM document Pre-Registration Education and Training of Dietitians, This document represented the implementation of recommendations from a major review of dietetics education and training instituted in 1992 and completed in 1996 (Judd et al, 1997). Implementation of these recommendations from 2000 onwards resulted in major changes to the structure and content of dietetics education and training which ensured that education and training is outcome led and that the academic and placement components are more integrated than previously. The transfer of the responsibility for the curriculum from the HPC to the BDA has afforded the opportunity to build on the previous developments and establish a curriculum framework which: Describes what is expected of newly-qualified dietitians and provides the basis for development of specialist skills and capacity for long-term career development. Enables the graduate dietitian to deliver evidence-based practice, problem solving and clinical reasoning within a multi-professional workforce. Takes into account the changes in dietetic practice, both within and outside the NHS, and allows for future developments in health care. Provides specific guidelines for the required content of qualifying programmes in dietetics whilst allowing flexibility for HEIs to develop their individual programmes. 4

5 Abbreviations and acronyms BDA CPD EBP HEI KSF HPC NHS PH PSB SET SOP QAA SHA CPSM UG PG The British Dietetic Association Continuous Professional Development Evidence-based practice Higher Education Institution Knowledge and Skills Framework Health Professions Council National Health Service Public Health Professional and statutory bodies HPC Standards of Education and Training HPC Standards of Proficiency Quality Assurance Agency for Higher Education Strategic Health Authority Council for Professions Supplementary to Medicine Undergraduate Postgraduate 5

6 Aims and purpose of the framework This curriculum framework aims to: Explain the British Dietetic Association s expectations for the content and conduct of programmes for which eligibility for registration as a dietitian is sought by: Describing the learning that qualifying programmes should enable students to achieve at the point of qualification. Describing the BDA s expectations for the delivery and quality assurance of programmes leading to eligibility for registration with the HPC. The document should be used in conjunction with the Health Professions Council (HPC) Standards of Proficiency for Dietitians (2007), the Quality Assurance Agency for Higher Education (QAA) Benchmarking Statements for Dietietics (2001), the HPC Standards of Conduct, Performance and Ethics (2003) and the relevant guidance on quality assurance of courses produced by the QAA (2001a, 2001b, 2006, 2006a, 2006b, 2007). Purpose The primary purpose of the document is to provide existing and aspiring providers of dietetics education with guidance on the curriculum content and delivery of dietetics programmes which should be used for planning and (re)validation. In addition it is expected that the document will be used as a reference document by: Representatives of the HPC and other statutory bodies in validation, revalidation, quality assurance and review of programmes. Dietetics programme providers, both teachers in academic institutions and clinical educators in training placement settings, to assist them in facilitating, supporting and assessing students. Dietetics students, to give an overview of the expectations of the breadth and depth of their learning and preparation for future practice. Employers of entry level dietitians, in understanding the breadth and depth of competence of new employees. 6

7 The role of professional and statutory bodies in the education and training of dietitians A number of professional and statutory bodies (PSB) have a role in the education and training of dietitians and relevant documents developed by these PSB have been considered during the review of dietetics education and training and the development of the curriculum framework. The British Dietetic Association (BDA) The BDA is the professional body for dietitians and as such is responsible for designing the curriculum for the profession, taking into account the philosophy, values, skills and knowledge essential for the practice of the profession. A number of BDA policy documents have been taken into account during the development of the Curriculum Framework including the joint BDA/CPSM Guidelines for Education and Training (2000), Professional Standards for Dietitians (2004), The Nutrition and Dietetics Care Process (2006). Health Professions Council (HPC) The HPC is the statutory body under which dietitians in the UK are registered and given licence to practise. The function of the HPC is as a regulatory body which protects the public. In order to do this the HPC keeps a register of health professionals who meet their standards for education and training, professional skills, behaviour and health. Institutions providing education and training which qualifies graduates for registration with the HPC must provide the academic knowledge and practical experience which enables the graduates to satisfy the HPC Standards of Proficiency (SOP) for entry level to the dietetics profession ( The SOP describe the threshold (minimum) standards expected of a graduate dietitian. The HPC accepts graduates from specific educational establishments as potentially eligible for registration on the basis of the education and training programmes provided although each candidate is considered individually. It is also involved in the approval and quality assurance of such programmes. Higher Education Institutions must comply with the HPC Standards of Education and Training (SET), and must demonstrate how they achieve this during approval and re-approval of dietetics programmes (see Appendix 1). HPC SET 4 describes the curriculum standards which must be achieved to ensure that graduates meet the HPC standards for professional skills and knowledge and are fit to practise. 7

8 Quality Assurance Agency for Higher Education The QAA is responsible for safeguarding the public interest through sound standards of higher education qualifications, and to encourage continuous improvement in the management of the quality of higher education. This is achieved by setting and reviewing standards of education of UG degrees in HEIs. The standards are described as Benchmarking Statements. The QAA recognises the key importance of teaching and learning within a practice setting, as well as within higher education institutions for programmes leading to dietetics qualifications and considers these as part of the regular major review (England and Wales) or other review processes. The curriculum guidelines produced here have considered the benchmarking statements for dietetics and the framework is closely linked with these such that it should be possible for HEIs to use the two sets of standards in tandem when planning and reviewing programmes. Other documents considered In order to align the Curriculum Framework with Europe and the expectations of the Departments of Health and NHS in the UK the following documents were consulted. European Federation of Dietetic Associations (EFAD) European Dietetic Benchmark Statement for the education and training of dietitians throughout Europe (2005). NHS Knowledge and Skills Framework (KSF) The Knowledge and Skills Framework developed by the Department of Health (2004) which describes the knowledge and skills required by entry level health professionals (Band 5) were considered when developing the framework. Skills for Health Skills for Health is the Sector Skills Council (SSC) for the UK health sector and considers the skills required for work in the NHS at all levels. ( 8

9 The role and scope of practice of the dietitian The key purpose of the profession of dietetics is stated in the international definition of dietetics agreed by the International Confederation of Dietetic Associations (ICDA) in A dietitian is a person with qualifications in nutrition and dietetics recognised by national authority(s). The dietitian applies the science of nutrition to the feeding and education of groups of people and individuals in health and disease. The scope of dietetic practice is such that dietitians may work in a variety of settings and have a variety of work functions. (Accepted by 34 dietetic association members at ICDA on May 24th, 2004, Chicago) The BDA description of a dietitian below expands on the international definition, illustrating the many aspects of dietetic practice which must be underpinned by the curriculum for education and training. Registered dietitians are the only qualified health professionals that assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. Uniquely, dietitians use the most up to date public health and scientific research on food, health and disease, which they translate into practical guidance to enable people to make appropriate lifestyle and food choices. Dietitians are the only nutrition professionals to be statutorily regulated, and governed by an ethical code, to ensure that they always work to the highest standard. Dietitians work in the NHS, private practice, industry, education, research, sport, media, public relations, publishing, non government organisations and government. Their advice influences food and health policy across the spectrum from government to local communities and individuals. (BDA Council 2007) This description recognises the expertise of dietitians in both normal and therapeutic nutrition. In the UK all dietitians are nutritionists, as all dietitians must have studied nutritional science, but not all nutritionists are dietitians, as they may not have completed essential components of the curriculum. In 2008 the majority of dietitians still work as therapeutic dietitians advising individuals on a one to one basis but the BDA recognises that the role and scope of practice for dietitians is continually changing and developing. Dietitians now work in diverse areas of practice including the acute and primary care sectors of the National Health Service, social services, private health care organisations, the food industry and as independent freelance consultants. Although the main employer of dietitians in the UK remains the National Health Service, the education and training of practitioners should prepare them for diversity of practice and to be adaptable to change in order to develop new and extended roles (BDA 2007, 2007a, 2007b). 9

10 An Educational Philosophy The BDA philosophy for education and training is grounded in the belief that sound pre-registration education and training is central to the delivery of high quality care to service users and that by underpinning subsequent lifelong learning this will ensure the development and continuation of such care. Every dietetic workplace should be a learning environment and should support the initial education and training of dietitians as well as their continuing professional development (CPD). The curriculum for pre-registration dietetics education should therefore support learning such that graduates will: Be competent to practise at entry level to the profession. Be able to practise independently and autonomously within the legal and ethical frameworks of the profession. Be able to practise autonomously from a sound evidence base, using clinical reasoning and problem solving skills. Be prepared to realise their full potential through lifelong learning. The expectation is that the curriculum will be developed by HEIs and dietetic practice educators so that the knowledge, skills and attitudes which underpin entry-level practice also instill a commitment to lifelong learning, opening the way for innovation and change in line with service needs. Recognition of the benefits of interprofessional learning and working will be encompassed within the delivery of education and training. Integration of theory and practice will provide the foundation for dietitians to develop flexible approaches to cope with change and uncertainty, whilst fostering commitment to the concepts of continuous quality improvement and extending and advancing practice through continuous professional development. 10

11 The BDA role in accreditation of programmes The British Dietetic Association intends to work with the key stakeholders who have an interest in the education, practice and development of dietitians to ensure that all UK programmes leading to eligibility for registration with the HPC maintain and support the further development of high standards of dietetic practice and conduct. The principle stakeholders with responsibility for the quality of pre-registration education of dietitians are: The HPC which determines the standards of education and training and the standards of proficiency for the profession to ensure the protection of service users. The HPC is concerned with fitness to practise. Education commissioners who identify the requirements of and for the profession in the public sector and are thus concerned with fitness for purpose. HEI, QAA and Skills for Health who are responsible for the quality of higher education and healthcare education and mainly concerned with fitness for award. The British Dietetic Association, which is responsible for the advancement of the science and practice of dietetics and the education of those engaged in dietetic practice and is concerned with overall fitness for the profession. The role of the BDA in education is therefore to safeguard the role and identity of the dietitian by clearly articulating standards for education and training of dietitians, producing guidance for education providers and monitoring these standards. The BDA will carry out these roles by acting to: 1. Provide support to course development teams by identifying a suitably experienced dietitian to act as a critical friend and advise on curriculum and course development. 2. Accredit pre-registration education at initial approval and revalidation. 3. Be aware if there are any issues which affect the quality of provision, obtain information and make recommendations for improvement and support individuals who wish to raise concerns about the quality of provision. 4. Maintain a list of external examiners. The HPC produce the Standards of Proficiency (SOP) (Dietetics) which articulate the knowledge, skills and attributes that a graduate from a programme must be able to demonstrate to be eligible for the register. The HPC also defines the Standards of Education and Training (SET). These generic standards describe what the HPC requires to see within a programme before they will approve or re-approve it. SET 4.2 articulates the expectation that these generic standards will be supported by the detailed, profession-specific curriculum now held by the BDA. The programme must reflect the philosophy, values, skills and knowledge base as articulated in the curriculum guidance for the profession (HPC, 2004). Within accreditation processes it is not the intention of the BDA to place a further onerous burden of proof on the HEI. In the following sections the BDA describes the profession specific expectations, which sit within and expand upon the generic SET of the HPC, thus providing details of the standards that the BDA believes are required to ensure that graduates are fit for the profession. Appendix 2 outlines the processes involved in BDA accreditation. 11

12 BDA expectations for Education and Training Programmes Whilst the overall responsibility for Education and Training rests with the HPC through the Quality Management Systems operated jointly with the QAA this document reiterates and expands upon the expectations of the HPC SET. Graduates with the following minimum UK qualifications are normally eligible for entry to the Dietetics Register: Bachelor degree with Honours in Dietetics or Nutrition and Dietetics. Masters degree in Dietetics or Nutrition and Dietetics. Postgraduate Diploma in Dietetics. Normally, applicants for postgraduate courses will have successfully completed an honours degree course which contains an acceptable level of human physiology and biochemistry. 1. Entry requirements for pre-registration programmes leading to registration Candidates must satisfy the entry requirements for approved courses. 1.1 Candidates will normally have qualifications in biology and chemistry and another science subject at advanced level i.e. a minimum of AS and preferably A2 where students take A-levels or the equivalent as Scottish Highers. 1.2 Other Qualifications Approved institutions may accept candidates with other qualifications of equivalent standard to those above e.g. International Baccalaureate, Access to Science, BTEC Diploma, foundation courses in science Candidates are normally expected to have GCSE at Grade C or above in English and mathematics or equivalent qualifications. 1.3 English language requirements. The HPC Standards of Proficiency for Dietitians (2007) for entry to the profession (HPC, SOP 1b.3) state that at the point of entry to the register applicants must be able to communicate in English to the standard equivalent to level 7 of the International English Language Testing System, with no element below 6.5. It is important that applicants to courses leading to eligibility for registration are not only able to achieve this level of English at exit from the course but that students have sufficient command of English to ensure that they are able to participate fully in the education and training process. The BDA therefore expects that entrants to courses leading to qualification in dietetics should comply with HPC, SOP 1b.3. 12

13 1.4 Accreditation of Prior Learning. The HPC requires that all programmes make provision for recognising prior learning. 1.5 Other admission requirements. HEIs must ensure that students recruited to a course leading to eligibility for registration comply with the HPC requirements with respect to criminal convictions, health and equal opportunities (HPC, 2004, SET 2). 2. Length and structure of dietetics programmes 2.1 All programmes leading to eligibility for registration as a dietitian should be of an adequate overall length to enable the acquisition and assimilation of underpinning knowledge and the integration and demonstration of skills required in practice. 2.2 In order to maintain currency of knowledge and skills the maximum time taken from entry to a dietetics programme until qualification as dietitian should normally be seven years for UG programmes and four years for PG programmes. 2.3 To ensure students have achieved the necessary level for safe practice at the point of registration it is expected that all elements of the indicative content will be rigourously assessed at appropriate points in the programme. 2.4 Students must obtain at least 40% in each module. In addition students must normally obtain at least 35% in each component of assessment within a module. A mark of between 35% and 39% may be compensated by other components. 2.5 Students should not normally proceed without satisfying all the requirements of the previous level of academic or practical education. This will include core modules which are considered mandatory to achieve the SOP. 2.6 Students should be expected to carry out a project which requires the demonstration of original and critical thought and appropriate research skills. 2.7 It is expected that periods of practical placement will be integrated with periods of academic education so that the students are able to adequately reflect on and learn from each element and that progression through the academic and practical components of the course can be demonstrated. 2.8 The current pattern of three practical placements (a four week placement early in the course followed by two separate 12 week placements) remains valid but it is recognised that HEIs may wish to operate different placement configurations in order to manage local situations, whilst ensuring delivery of the SOP. 13

14 14 In order to allow flexibility in placement provision the guidelines below should be followed: Students will normally be expected to undertake not less than 1000 hours of practical learning and experience outside the HEI throughout the programme. Placements should be integrated with academic learning and include a placement in the workplace early in the academic course. At least one placement should be of sufficient length to enable continuity of learning and demonstrate consistency of performance and case load management in an acute/clinical setting. This placement should be not less than 350 hours long, and would be expected to be undertaken on a continuous, full-time basis within a year of graduation. Programmes which include an extended academic period after the final practical placement should demonstrate how competence to practise is maintained until the point of graduation. The sites of the practical placement should reflect the breadth and diversity of the working environments of entry-level dietitians but must include some time in acute and primary care dietetics placements and public health or health promotion. 2.9 Repeat placements Students should normally be allowed to extend or repeat not more than 500 hrs (or 50% of the total hours) of practical placement in total in order to qualify ie. the maximum number of hours placement overall will be Any designated period of clinical placement may normally only be repeated once. Students absent from placement through sickness will normally be expected to make up an agreed number of hours subject to discussion between the HEI and named practical trainer. This will take account of current performance and potential effects on future progression. 3. Curriculum delivery 3.1 Higher Education Institution (HEI) There should normally be a named programme leader with overall responsibility for the programme who is on the HPC register for dietitans and a member of the BDA Subject areas should be taught by staff with relevant subject and specialist knowledge and expertise e.g. it would be expected that nutrition would be taught by a nutritionist with an academically recognised qualification in human nutrition.

15 3.1.3 Where a subject is taught in an inter-professional setting, the profession specific skills and knowledge must be acknowledged Whilst it is not possible to set a requirement for staff student ratios it would be expected that a minimum of one full-time equivalent registered dietitian be employed for every 12 students recruited to the first year of the dietetics programme(s). It is recognised that HEIs now make flexible arrangements for teaching and learning including involving specialist practitioners in the teaching of dietetics. However, it would be expected that at least one of the registered dietitians be a full-time academic appointment and make a significant contribution to the dietetics programme i.e. in teaching, project supervision, personal tutoring and course management roles It is expected that some teaching will be carried out by dietitians and other healthcare professionals who are active in practice relevant to the area being taught It is expected that at least one of the external examiners for programmes leading to registration in dietetics will be an experienced practising dietitian. 3.2 Practical placement provision All placements will be approved and the quality actively monitored by the HEI It is expected that all qualified dietitians will contribute to practical placement education in ways commensurate with their qualifications and experience and after undertaking appropriate training Overall responsibility for the supervision and assessment of students on placement will be taken by an experienced dietitian with training in supervision and assessment. This dietitian will be responsible for the final assessment of the student Appropriately qualified health and social care professionals may assess and provide evidence for achievement of particular placement outcomes Normally the HEI will ensure consistency of documentation and assessment tools for the group of placement providers with whom their students are placed It is expected that HEIs and placement providers will work together to provide ongoing training in supervision and assessment for those dietitians involved in student training HEIs should demonstrate partnership working with their practice educators including adequate and timely communication about individual students, changes in curriculum and student feedback. 15

16 4. Quality Assurance (QA) 4.1 Systems for quality assurance of dietetics education and training vary from country to country within the UK and are currently under review. 4.2 It is expected that all education providers will have a robust system for quality assurance which will usually involve local (HEI) procedures, the Health Professions Council and the Higher Education Quality Assurance organisation within their country. 4.3 It is expected that each HEI will be responsible for assuring the quality of the practical placements for which they are responsible and to which their students are usually assigned. 4.4 It is expected that the QA procedures will be responsive to feedback from all parties including academic staff, practice educators and students. 16

17 The Curriculum Framework The curriculum framework describes the content of the curriculum for dietetics education and training in terms of the expectations of the learning acquired by the end of the education and training programme. It provides the broad outline of the areas of basic science and social science considered essential to underpin dietetics practice together with the knowledge base of nutrition and dietetics and the skills essential to apply all these in practice. It is expected that the HEIs and their practice partners will use this to develop their own specific learning outcomes for each level of the education programme and for the practice placements. It is not expected that the elements of learning described below should always be addressed precisely as described below within the HEI curricula but that they should be subsumed within the overall design of dietetics education and training programmes in such a way as to ensure that all aspects are covered. Educational institutions, together with their practice educators, should be able to use the statements contained within this document to describe the learning outcomes for the academic and practical components of dietetics programmes in ways which show progression through the various stages leading to qualification. There are four main sections, the first two describing the knowledge and skills required by entry level dietitians. The remaining sections put these knowledge and skills into the context of practice as a dietitian and describe the expectations of the application of the knowledge and skills in practice in order to achieve Standards of Proficiency required by the HPC. The HPC Standards of Proficiency (Dietitians) are the threshold (minimum) standards for entry level dietitians and it is accepted that HEIs may produce graduates whose knowledge, skills and practical application go beyond these basic levels in some aspects. The curriculum content has been described in such a way that those involved in the education and training of dietitians can develop distinctive programmes where the institution s own educational philosophy complements that of the BDA and HPC. Some institutions, for example, may choose to place more importance on the development of research expertise, or on the public health or catering aspects of dietetics for their graduates than the threshold level described here. 17

18 The context of dietetic practice The detailed curriculum framework given below is based on an expectation that graduates who are eligible for registration will understand and have the ability to work within the wide-ranging sphere of influence of dietetics. It is expected that at the point of registration a graduate in dietetics from an approved course will have the ability to work autonomously, with practice based on sound evidence, in therapeutic roles with individuals and more broadly, in health promotion and public health with both individuals and groups. The curriculum content should therefore always be placed in this context and graduate dietitans will therefore: Demonstrate confidence in delivering an explicit quality of dietetic service. Demonstrate the ability to work autonomously with individual clients on a one to one basis assessing needs, providing theraputic advice and facilitating behaviour change based on the clinical and personal information available as well as the evidence base for practice. Demonstrate the ability to work with individuals and groups translating the most up to date public health and scientific research on food, health and disease into practical advice to facilitate behaviour change and enable people to make appropriate lifestyle and food choices. Show awareness of his/her role and sphere of influence within the organisation, and demonstrate the ability to work in a collaborative manner with a range of healthcare professionals and other staff in enabling safe and effective dietetic service delivery. Understand the limits of his/her current scope of practice and work within these. Demonstrate awareness of the clinical risk associated with any dietetic care plan. Show understanding of the role and responsibility of the dietitian as an advisor who can influence positively the wider social, commercial and political environment for the modification of factors that influence eating behaviour, and national and local nutritional standards. Show familiarity with government policies for the provision of health care as they impinge on the dietetic service. Show understanding of policy issues concerned with public health nutrition in the United Kingdom (UK). Demonstrate familiarity with the current systems for the provision of health care, education and social sciences and recognise opportunities to influence health and social policy and practices. 18

19 Knowledge underpinning informed, safe and effective practice The practice of dietetics requires a broad range of knowledge. Dietetics is firmly based on an understanding of biological sciences and it is expected that adequate learning opportunities in the basic and applied sciences underpinning nutrition and dietetics will be a major component of pre-registration dietetics programmes. This will be complemented by adequate knowledge of social and behavioural sciences and the theories of communication in order to support the development of the skills required for dietetic practice. Knowledge of research methodology and ways in which practice can be evidence-based and develop is also vital, along with the information technology which supports this. Graduate dietitians are therefore expected to: Demonstrate a systematic understanding of the key aspects of the range of disciplines underpinning dietetics. Demonstrate the ability to critically evaluate and synthesize these key aspects into dietetic care. The elements of the knowledge base are described on the following pages, together with indicative content in each case. 19

20 Detailed, integrated and applied knowledge of BIOCHEMISTRY Indicative content Principles of biochemistry and integration of knowledge acquired in physiology and nutrition with biochemistry. Major metabolic pathways. Cellular and molecular basis of disease. Factors affecting biochemical measurements and reference standards. Evaluation and interpretation of relevant biochemical and medical data for complex conditions. Metabolic effects of common clinical conditions relating to over nutrition, under nutrition and metabolic stress. Detailed, integrated and applied knowledge of PHYSIOLOGY Indicative content Structure of the human body at both macro and cellular level. Role, function and regulation of major body systems in health and disease. 20

21 Broad knowledge and understanding of GENETICS and its application Indicative content Principles of genetics, nutrigenomics and nutrigenetics. Understanding of the genetic basis of disease and application in dietetic practice. Broad knowledge and understanding of IMMUNOLOGY and its application Indicative content Principles of immunology. Understanding of immunology and its application in dietetic practice. Broad knowledge and understanding of MICROBIOLOGY and its application Indicative content Principles of microbiology and food hygiene. Knowledge of micro-organisms most commonly associated with infection of all groups of the population and how to minimise the spread of infection. Clinical microbiology and its application to dietetic practice. Causes and prevention of food spoilage and food-borne disease and strategies for prevention. 21

22 Integrated knowledge and applied understanding of CLINICAL MEDICINE Indicative content Principles of pathology and clinical management of diseases where there is a nutritional aetiology or where nutritional or diet therapy have a significant role. Integrated knowledge and applied understanding of PHARMACOLOGY Indicative content The modes of action of the main types of drugs. The functions, side effects and contraindications of drugs used in the treatment of diseases in which a dietitian is usually a key member of the clinical team. Drug nutrient interactions and the use of nutrients as pharmacological agents. 22

23 Detailed, critical, integrated and applied knowledge and understanding of NUTRITION Indicative content Role and function of energy and nutrients in human metabolism including: i. Requirements through the lifecycle. ii. Effects of deficiency and toxicity. iii. Food sources. The impact of nutrients on cellular mechanisms, including gene expression, and the contribution to diet related disease and its management. Role and function of non-nutritive dietary components in human metabolism. The role of functional foods. The measurement and interpretation of biochemical, anthropometric, nutritional, dietary and clinical data to determine nutritional status of individuals and populations and their limitations. The UK diet, including sub group differences such as region, ethnic origin, socio economic status. Factors which affect food choice across the life cycle. The effects of economic and socio-economic factors on food choice. Factors that determine food choice in achieving current dietary guidelines. Methods of optimising nutritional status at an individual and population level. The interaction of diet and other environmental factors in the prevention of disease. Policy issues concerned with public health nutrition in the UK and overseas. 23

24 Broad Knowledge and understanding of SOCIOLOGY and SOCIAL POLICY Indicative content Systems of social organization. Inclusion, exclusion, diversity and health inequalities. The social factors which shape an individual s lifestyle and how these may affect the interaction between the dietitian and service users. Concepts of status, role, social networks and social mobility relating particularly to health and healthcare. Concepts of socialization and the application to stages in the life cycle. Classification systems and the use of social class in relation to UK health statistics. Origins, changes and current eating patterns of different population groups in the UK. Sociology of food choices and lay health beliefs including complementary therapies. Current systems for the provision of healthcare, education and social services in the UK. Factors influencing development of policy with respect to health and social care. Relevant government policy with respect to the health and social care of service users commonly using dietetics services. Broad knowledge and understanding of PSYCHOLOGY Indicative content Theories of human behaviour. The psychological background to health behaviour. Theories of behaviour change and behaviour modification as applied to dietetic practice. Understanding the psychological dimension of the dietitian client relationship. The psychological dimensions of hunger, satiety and food choice. The psychological aspects of normal and disordered eating. The psychology of eating disorders. Psychological aspects of long term conditions. 24

25 Detailed and applied knowledge of COMMUNICATION AND EDUCATIONAL METHODS Indicative content Different methods and styles of communication required for interacting with service users, colleagues at all levels and the general public. Principles of oral communication necessary for interaction with individuals and groups. Principles of written communication necessary for all aspects of practice including report writing, communicating with service users and colleagues and record keeping. Team working - need to work with others as an individual and as part of a team awareness of self and others and how to seek and accept guidance. Barriers to communication and ways in which these may be overcome. Theories of communication including counselling and behavioural science. Theories of behaviour change and behaviour modification as applied to dietetic practice. Principles of education theory as it applies to dietetic practice. Theories of learning and education including the principles of adult learning as applied to individuals and groups. Teaching methods available to teach others to teach including support workers, student dietitians, food workers. The range of resources available to prepare and make educational materials for individuals and groups of varying types. 25

26 Detailed and applied knowledge of FOOD Indicative content Range and relative cost of foods available to the general public including nutrient modified foods. Commonly consumed foods, including convenience foods and their nutrient content. Portion sizes of common foods. Understanding of derivation and limitations of food composition data. Use of food tables and computerised dietary analysis packages for individual assessments, recipe analysis and menu planning. The range, suitability and costs of foods for therapeutic diets. Use of standard recipes and recipes modified with products specifically for use in therapeutic diets. 26

27 Broad knowledge and understanding of FOOD SCIENCE AND FOOD SYSTEMS MANAGEMENT Indicative content Methods of food preservation. Effects of food production, preparation and processing on the nutrient content of food on both domestic and large scale levels. Food fortification and food enrichments. Types and use of food additives. Food analysis and estimation of food consumption including additives and nutrients. Patterns of food marketing, distribution and consumption. Food labelling regulations and legislation including health claims for food. Principles of catering management within the public sector (health and social care and education) including different methods of food provision, preparation, distribution and quality control. Menu planning for healthy individuals and groups, appropriate for different ages and cultural backgrounds. Modification of menus for specific dietary requirements. Financial and institutional constraints on menu planning. Development, implementation and monitoring of nutritional standards for catering services. Application of food hygiene and HACCP (Hazard Analysis and Critical Control Point). 27

28 Extensive critical, integrated and applied knowledge of DIETETICS for the prevention and treatment of disease Indicative content The dietetic care process. Qualitative and quantitative methods for assessment of food and nutrient intake including dietary interviews, history taking and recording. The ways in which the nutritional and dietetic needs of individuals, groups and communities are assessed to achieve a dietetic diagnosis, common therapies and patient management. Anthropometric methodology, reference standards and their application and limitations. Evaluation of biochemical and clinical data in specific disorders requiring dietary modification. Dietetic diagnoses, how these differ from those of other professions involved in treating the patient and how these interact. Use of dietary modifications in diagnosis and research. The rationale for modification of energy and nutrient intake and how modifications are applied in the overall prevention and treatment of disease. Calculation of nutritional requirements for patients and translation of this into practical advice and care planning. Use of current nutrient exchange systems (eg. for carbohydrate and protein) for delivery of dietary advice. Specific dietary modifications in the treatment of named diseases and the practical advice necessary to enable patients of differing educational, cultural and socio-economic backgrounds to achieve the necessary changes. Methods of optimising nutritional status in health and disease. Methods of fortifying/modifying foods and diets. Artificial nutrition including enteral and parenteral feeding. Types and use of nutritional products available on prescription and the dietitian s role in ordering these. Knowledge and understanding of nutritional, dietary and lifestyle goals and how these influence the outcomes for the individual or group. Lifestyle modification in the treatment and prevention of disease. Knowledge of the dangers of dietary manipulation and how to manage the consequences for the individual. An understanding of the legal aspects of medicine management. Methods of monitoring and evaluation of dietary treatment. 28

29 Detailed knowledge and understanding of PUBLIC HEALTH Indicative content Theories of public health. Theories of health education, health promotion, health advocacy and community development. Definition and philosophies of public health movements. National and international health and nutrition policies, i.e. local, government EU and international, e.g. World Health Oragnisation (WHO). Needs assessment of communities and populations. Use of demographic, epidemiological, anthropometric and nutrition survey data in developing and evaluating PH strategies. Principles of programme management, including assessment, planning, implementation and evaluation. Health promotion and PH strategies designed to promote behavioural change. Role of the dietitian and the multidisciplinary team in health education and health promotion. 29

30 Critical understanding of the concepts and theories of RESEARCH AND EVALUATION Indicative content Principles of scientific enquiry. Principles of evidence-based practice including critical appraisal of the literature. Familiarity with sources of evidence, guidelines and systematic reviews. Familiarity with the process of systematic review and meta-analysis. Principles of audit and evaluation of practice as applied to dietetics. Principles of epidemiology and ways in which descriptive and analytical epidemiology can be applied in clinical and public health dietetic practice. Principles of research design, data management and statistical analysis and interpretation. Research ethics and research governance. Qualitative and quantitative research methodology. Knowledge of the design, execution, analysis and report on an aspect of dietetics research which allows the demonstration of original thought and a critical approach to research. 30

31 Detailed knowledge of PROFESSIONAL ISSUES Indicative content The legal and ethical boundaries of practice. Familiarity with and understanding of: The HPC Standards of conduct, performance and ethics, and Standards of proficiency for dietitians. The role of the Health Professions Council and the British Dietetic Association. The BDA Professional Standards for Dietitians. The BDA Code of Professional Conduct. The role of the dietitian in the NHS and other areas of work. Inter-professional working. Requirements for continuing professional development (CPD). The use of reflective practice and self-evaluation. 31

32 Broad knowledge and understanding of public sector ORGANISATIONS AND MANAGEMENT Indicative content Organisational structures and management relating to health systems, social care and the private sector. The current organisation of health care delivery within the UK with reference to dietetics. The role of the dietetic service within and outside the NHS including the role of the dietetic manager. Levels of responsibility of dietitians and other colleagues in achieving an explicit quality of service. Knowledge and application of service improvement principles. Management and leadership styles. Use of health information for planning, developing and evaluating services. Business planning and principles of financial planning, tendering and contracting. Measuring outcomes and evaluation of healthcare services. Clinical governance and quality management including standard setting, audit and evaluation. The role of clinical (practice) supervision. Principles of human resource management and industrial relations. Time management and setting priorities for the individual and as part of a team. 32

33 Skills that are essential to underpin informed, safe and effective practice of dietetics Dietetic practice is underpinned by the integration of knowledge and understanding drawn from the wide range of disciplines described in the knowledge section of this document. It is necessary for students to incorporate this knowledge and understanding into the acquisition and demonstration of a range of complex skills. It is expected that these skills will be developed progressively through qualifying programmes which integrate the academic and skills-focused learning. It is axiomatic that the ability to communicate effectively with individuals and groups at all levels underpins all aspects of a dietitian s practice. It is important that attention is paid to the development of communication skills throughout both the academic and practical components of programmes. The section below describes the elements of skills underpinning safe practice and indicators of outcomes. The ability to practice safely and effectively within the individual s scope of practice Indicators Demonstration of the ability to: Maintain standards and the requirements for initial and continuing registration. Demonstrate an understanding of the dietitian s role both within and outside the NHS. Exercise a professional duty of care to service users. Understand the limits of their practice and when to seek advice or refer to another professional. Reflect on action and in action and change their practice in response. Demonstration of an understanding of the need for continuing professional development (CPD) and take responsibility for professional development. Demonstration of the ability to: Reflect on practice and areas for continuing professional development. Be aware of the developing evidence base for dietetics. Maintain a professional portfolio. 33