Consultation Document: Seeking Feedback on Performance Indicators for Inclusion in the Integrated Competencies for Dietetic Education and ...
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Consultation Document: Seeking Feedback on Performance Indicators for Inclusion in the Integrated Competencies for Dietetic Education and Practice, v3.0 To access the online feedback survey click here: https://www.surveymonkey.com/r/WNL6HTB BUT BE SURE TO CAREFULLY STUDY THIS DOCUMENT FIRST! 1
Preamble The Partnership for Dietetic Education and Practice (PDEP) is nearing completion of the final steps in developing the 2020 update to the Integrated Competencies for Dietetic Education and Practice (ICDEP). Purposes of ICDEP ICDEP serves two purposes: 1. It describes the minimum set of practice abilities that a dietitian is expected to possess at the point of entry-to-practice. These abilities are called Practice Competencies (PCs). 2. It delineates the manner in which possession of the PCs is to be assessed pre-registration. Assessment is required in three distinct settings: i. Within the academic component of education programs ii. Within the practicum component of education programs iii. In the Canadian Dietetic Registration Examination (CDRE) While each assessment setting has inherent advantages and constraints, all assessment takes place pre-licensure; therefore no setting is able to directly measure candidate performance in practice (practice being the context of the PC). For this reason, explicit expectations for performance in each assessment setting are captured in behavioural descriptors called Performance Indicators (PIs). Evolution of ICDEP since v2.0 (2013) PDEP’s ICDEP v3.0 Working Group developed modified Domains of Competence (formerly known as Areas of Practice), a revised Statement of Entry-Level Proficiency, and updated PCs, with widespread stakeholder consultation, over the period January 2018 through June 2019. The 7 inter-related Domains of Competence are illustrated in the chart on the cover page. As the chart suggests, the Domains of Competence overlap and inform one another. It also signifies that Food & Nutrition Expertise is central to all activities carried out in the common practice domains of Nutrition Therapy, Health Promotion and Food Provision. Professionalism & Ethics, Communication & Collaboration and Leadership frame and inform the practice domains. Within the Domains there are 54 PCs, from which a total of 227 PIs have now been drafted. For ICDEP v3.0, four significant modifications have been proposed in approach: 1. The Foundational Knowledge (FK) specifications in v2.0 (which were content- based statements of the broad knowledge base necessary to perform the PCs) have been replaced by performance-based PIs. To accommodate this in part, the new Domain Food & Nutrition Expertise was developed. 2
2. The number of assessment statements has been reduced by almost 50% (from a total of 441 PI/FK statements in v2.0 to 227 PIs in v3.0), in an effort to streamline ICDEP and reduce redundancy. 3. The former Area of Practice Management, which contained PCs involving food service operations as well as more generic management skills, has been separated into two Domains: Leadership and Food Provision. 4. A modified version of Miller’s Pyramid of Clinical Competence (see below) has been developed and is now used to specify the nature of assessment required of PIs within the three assessment settings. Statement of Entry-Level Proficiency ICDEP is an entry-to-practice standard. Education and assessment should be structured to reflect performance consistent with the following statement of entry-level proficiency: Entry-level dietitians independently apply routine approaches consistent with standards and best practices in the profession. They recognize situations beyond their capacity and take appropriate steps to ensure that such situations are addressed safely and ethically. With experience and further education, knowledge, abilities, judgement and efficiency evolve consistent with practice. The Nature of Assessment Required The nature of assessment required in each assessment setting has been identified using a PDEP-developed adaptation of Miller's Pyramid of Clinical Competence.1 Represented graphically as shown below, this hierarchy of assessment methodologies consists of 4 behavioural levels labelled Knows (K) / Knows How (KH) / Shows How (SH) / Does (D). The nature of the assessment required is provided in the PC/PI grid, and is reflected in the verb used in wording the PI statement: Nature of Assessment Verbs used in corresponding PI statement Knows (K) Demonstrate awareness; demonstrate knowledge Knows How (KH) Demonstrate understanding Shows How (SH) An action verb connoting: perform in simulation Does (D) An action verb connoting: perform in the workplace 1 For origin see: G. E. Miller. The assessment of clinical skills/competence/performance. Acad Med 1990;65:S63-67, and A. Gwilliam. TrueAbility. 2018; retrieved from https://i1.wp.com/www.trueability.com/wp-content/uploads/2018/08/Millers-Pyramid-.jpg?ssl=1 3
Nature of PI Assessment Development towards competence in practice DOES Assessment based on observation* of performance in the workplace Assessment based on observation* of performance, in a workplace simulation, typically taking place in an academic SHOWS HOW education setting Assessment based on application of knowledge in the KNOWS HOW context of practice, demonstrated in multiple-choice testing, case study, written or oral assessment, taking place in an academic education setting or the CDRE Assessment based on possession of knowledge, demonstrated in multiple choice testing, written or oral KNOWS assessment, taking place in an academic education setting or the CDRE * Observation may be direct (undertaken by the assessor) or indirect (anecdotal, based on discussion with others) Here is an example of how the adaptation of Miller’s Pyramid should be applied to the PIs: Consider PC 1.06: Ensure appropriate and secure documentation, and specifically PI 1.06a: Document relevant information accurately and completely, in a timely manner. PI 1.06a describes the behaviour to be assessed. Aspects of this behaviour can be assessed at any of the 4 Miller levels: Knows assessment: This would indicate that the student knows about the characteristics of documentation normally required, devoid of any specific context or application. This could be determined via a written test, an oral test, or a multiple choice question. Knows How assessment: This would indicate that in addition to Knows, the student would be able to identify the characteristics of documentation that would apply in a specific context of practice or practice scenario. Similar to Knows, Knows How performance could be determined via a written test, an oral test, or a multiple choice question. 4
Shows How assessment: This would indicate that the student can actually perform the required task of documenting appropriately, based on observation of her/his performance in a simulation of practice such as a food/communication lab, a simulation with a standardized patient, a computer-based simulation, etc. Does assessment: This would indicate that the student can actually perform the required task of documenting appropriately in a practice setting, based on observation of her/his performance in the dietetic workplace. Such observation may, for example, involve a preceptor reviewing and assessing the student’s chart notes for accuracy, completeness and timeliness following a patient interaction. It is only at the Does level that the student performs in a setting that closely mirrors what real-life practice may be like; thus Does assessment is sometimes considered to be the ‘gold standard’ relative to clinical competence and it lies at the top of the pyramid. That said, dependent on the nature of the PI, Does assessment may be neither feasible nor sufficiently comprehensive in the practicum setting. Note that with reference to the PC/PI grid (see page 6 of this document) the required assessment for PI 1.06a is Knows How in academic and Does in practicum. The PI Consultation Process and the Finalization of ICDEP v3.0 The period of final consultation on ICDEP v3.0 will take place over the period October – November 2019, and will seek feedback from individuals involved in the provision and assessment of entry-to-practice education. It will be survey-based. If you wish to provide feedback it is essential that you spend some time examining the PC/PI grid below. To view and respond to the feedback survey, go to: https://www.surveymonkey.com/r/WNL6HTB In order to respond you will need to have this Consultation Document available for reference. The survey will close at the end of the day on November 24 2019, Pacific time. Over the period December 2019 – February 2020 CDRE management personnel will be asked to identify PIs that will incorporated into the CDRE blueprint. In early 2020 an ICDEP Interpretation Guide will be prepared. This will include an introduction to dietetic practice in Canada, information about the structure and purposes of ICDEP, and a glossary of key terminology with definitions and references. Final approval of ICDEP v3.0 by the PDEP Steering Committee is anticipated in April 2020. Within approximately two years of implementation, PDEP is expected to initiate a user feedback process that may result in some minor operational refinements. 5
PC / PI GRID Practice Competencies Performance Indicators (PIs) (abilities expected of the dietitian at PI Assessment Required (performance that will be assessed prior to registration) entry-to-practice) Terms in red will be defined in the ICDEP Interpretation Guide Academic1 Practicum1 CDRE2 1 Academic / Practicum assessment coding is based 1. Professionalism and Ethics on an adapted Miller's pyramid: 1.01 Practice within the context of Canadian diversity K = Knows; KH = Knows How a Demonstrate knowledge of Canadian food, health and social systems K SH = Shows How; D = Does 2 b Demonstrate understanding of the impact of diverse attitudes and values on health KH CDRE assessments have not yet been determined c Act in a manner that supports health equity and social justice SH D 1.02 Practice according to legislative, regulatory and organizational requirements a Demonstrate knowledge of federal requirements relevant to dietetic practice K b Demonstrate knowledge of provincial / territorial requirements relevant to dietetic practice K Demonstrate knowledge of regulatory scope of practice, bylaws, standards of practice and c K codes of ethics d Adhere to regulatory requirements D e Comply with organizational policies and directives D 1.03 Act ethically and with integrity a Treat others with respect SH D b Act in a manner that engenders trust SH D c Act in accordance with ethical principles SH D d Accept accountability for decisions and actions SH D e Act in a manner that upholds the reputation of the profession SH D f Maintain professional boundaries KH D 1.04 Act in a manner that promotes cultural safety Act with awareness of how a dietitian's biases, beliefs, behaviours, power and privilege a KH D may affect others b Demonstrate understanding of cultural sensitivity and humility KH Demonstrate awareness of Indigenous values and ways of knowing related to health and c K wellness Demonstrate knowledge of the ongoing impact of colonization / residential schools / d K intergenerational trauma / systemic racism on Indigenous peoples in Canada Demonstrate awareness of the role of self-determination in supporting capacity e K development 1.05 Employ a client-centred approach a Demonstrate knowledge of principles of a client-centred approach K b Ensure informed consent KH D c Identify client perspectives, needs and assets KH D d Engage client in collaborative decision making KH D e Maintain client confidentiality and privacy KH D 1.06 Ensure appropriate and secure documentation a Document relevant information accurately and completely, in a timely manner KH D b Maintain security and confidentiality of records KH D 1.07 Practice in a manner consistent with principles of safety a Demonstrate knowledge of risks inherent in practice settings K b Identify risks and hazards in the practice setting D c Contribute to an organizational culture of safety KH D 1.08 Manage time and workload a Prioritize activities KH D b Meet deadlines SH D 1.09 Employ an evidence-informed approach to practice a Demonstrate knowledge of factors that contribute to decision making K b Demonstrate knowledge of the process of evidence-informed decision making KH c Make evidence-informed decisions KH D 1.10 Engage in the process of reflective practice a Demonstrate knowledge of principles of reflective practice K b Assess effectiveness of practice D c Seek resources to improve practice D 1.11 Practice within limits of current personal level of professional knowledge and skills a Articulate individual level of professional knowledge and skills KH D b Identify situations which are beyond personal capacity D c Address situations beyond personal capacity D 1.12 Maintain comprehensive and current knowledge relevant to practice a Use relevant terminology SH D b Identify relevant sources of information KH D c Critically appraise information relevant to practice KH D d Identify emerging information relevant to practice K D 1.13 Use informatics to support practice a Demonstrate knowledge of information technologies relevant to practice K b Use information management software SH D 1.14 Maintain personal wellness consistent with the needs of practice a Identify personal assets and barriers affecting practice SH D b Address personal barriers affecting practice SH D Consultation Version Oct-Nov 2019 6
PC / PI GRID Practice Competencies Performance Indicators (PIs) (abilities expected of the dietitian at PI Assessment Required (performance that will be assessed prior to registration) entry-to-practice) Terms in red will be defined in the ICDEP Interpretation Guide Academic1 Practicum1 CDRE2 1 Academic / Practicum assessment coding is based 2. Communication and Collaboration on an adapted Miller's pyramid: 2.01 Use appropriate communication approaches K = Knows; KH = Knows How a Identify opportunities for and barriers to communication relevant to context KH D SH = Shows How; D = Does 2 b Use communication approaches appropriate to context SH D CDRE assessments have not yet been determined c Use language appropriate to context SH D 2.02 Use effective written communication skills a Write in a manner responsive to the needs of the audience SH D b Write clearly and in an organized fashion SH D c Use correct grammar and spelling SH D 2.03 Use effective oral communication skills a Speak in a manner responsive to the needs of the audience SH D b Speak clearly and in an organized fashion SH D c Use appropriate tone of voice SH D 2.04 Use appropriate digital platforms for communication a Demonstrate knowledge of digital communication platforms, and their appropriate uses K b Use digital communication platforms relevant to context SH D 2.05 Use effective interpersonal skills a Employ principles of active listening SH D b Use and interpret non-verbal communication SH D c Act with empathy SH D d Establish rapport SH D e Employ principles of negotiation and conflict management SH D f Seek and respond to feedback SH D g Provide constructive feedback to others SH D 2.06 Engage in teamwork a Demonstrate knowledge of principles of teamwork and collaboration K b Contribute effectively to teamwork SH D 2.07 Participate in collaborative practice a Identify scenarios where dietetics knowledge is a key element in collaborative practice K b Identify scenarios where the expertise of others is a key element in dietetic practice K c Facilitate interactions and discussions among team members SH D d Contribute dietetics knowledge in collaborative practice KH D e Draw upon the expertise of others KH D f Contribute to effective decision making SH D 3. Leadership 3.01 Assess and enhance approaches to practice a Conduct a situational analysis SH D b Analyze, interpret and consolidate evidence to establish a course of action SH D c Plan the implementation of change SH D d Plan the evaluation of change SH D 3.02 Participate in practice-based research a Frame research questions SH D b Critically appraise literature SH D c Use relevant research methodology SH D d Interpret research findings SH D e Communicate research findings SH D 3.03 Use management skills a Contribute to strategic and operational planning KH D b Contribute to human resource management KH D c Contribute to financial management KH D d Contribute to physical resource management KH D 3.04 Advocate for ongoing improvement of nutritional health and care a Identify opportunities for advocacy K D b Identify strategies for effective advocacy KH D c Engage in advocacy relevant to practice setting D 3.05 Foster learning in others a Identify opportunities for learning K D b Assess learning needs and assets SH D c Develop appropriate learning outcomes SH D d Implement appropriate educational strategies SH D e Assess achievement of learning outcomes SH D 3.06 Undertake knowledge translation a Identify food- and nutrition-research knowledge relevant to others K D b Reframe knowledge into a format appropriate for other users SH D 3.07 Foster development of food literacy in others a Identify strategies to assist the development of food literacy KH D b Engage in activities to build food literacy SH D Consultation Version Oct-Nov 2019 7
PC / PI GRID Practice Competencies Performance Indicators (PIs) (abilities expected of the dietitian at PI Assessment Required (performance that will be assessed prior to registration) entry-to-practice) Terms in red will be defined in the ICDEP Interpretation Guide Academic1 Practicum1 CDRE2 1 4. Food and Nutrition Expertise Academic / Practicum assessment coding is based on an adapted Miller's pyramid: 4.01 Apply understanding of food composition and food science K = Knows; KH = Knows How a Demonstrate understanding of physical and chemical properties of food KH SH = Shows How; D = Does 2 b Demonstrate understanding of food processing and preservation KH CDRE assessments have not yet been determined Demonstrate understanding of the role of ingredients and their interaction in food c KH preparation d Demonstrate understanding of the sensory evaluation of food KH e Demonstrate understanding of microbes in food KH f Identify sources of micronutrients and macronutrients in foods K g Identify sources of non-nutrient functional components in food K 4.02 Apply understanding of food environments a Demonstrate knowledge of government policy in regulating food products in Canada K b Demonstrate understanding of factors affecting food systems** in Canada KH c Demonstrate awareness of Indigenous values and ways of knowing related to food K d Demonstrate understanding of factors affecting the food security*** of Canadians KH e Demonstrate understanding of factors affecting food safety KH f Demonstrate understanding of sustainable food systems and practices KH 4.03 Use food skills a Create food plan based on client situation KH b Select food appropriate to client situation KH c Interpret food label to assist in food selection KH d Critically appraise food messaging and marketing to assist in food selection KH e Demonstrate food preparation techniques SH Demonstrate awareness of the availability and preparation of Indigenous traditional / f K country foods g Demonstrate understanding of food modifications to address client needs KH 4.04 Apply understanding of human nutrition and metabolism a Demonstrate understanding of the role of nutrients and other food components KH Demonstrate understanding of the processes of ingestion, digestion, absorption and b KH excretion c Demonstrate understanding of metabolism KH 4.05 Apply understanding of dietary requirements and guidelines Demonstrate understanding of dietary requirements across the lifespan, in health and a KH disease Demonstrate understanding of the role of physical activity and energy balance in b KH determining dietary requirements c Demonstrate understanding of how deficiencies and toxicities of nutrients affect health KH d Demonstrate understanding of current nutrition recommendations and dietary guidelines KH e Demonstrate understanding of the role of supplements in meeting dietary requirements KH 4.06 Apply understanding of dietary practices a Demonstrate understanding of behavioural theories relevant to food choice and eating KH b Demonstrate understanding of psychological and social aspects food choice and eating KH c Demonstrate understanding of the impact of financial resources on food choice and eating KH Demonsrate understanding of the inter-relationship between the environment and dietary d KH practices e Demonstrate knowledge of cultural and religious impacts on dietary practices K Demonstrate awareness of the role of Indigenous traditional / country foods in dietary f K practices g Demonstrate knowledge of trends in food consumption K 4.07 Integrate nutrition therapy fundamentals and practices a Demonstrate knowledge of human physiological systems in health and disease K b Demonstrate knowledge of the etiology and pathophysiology of nutrition-related diseases K c Demonstrate knowledge of nutrition-related disease management strategies K d Demonstrate understanding of the nutrition care process KH e Demonstrate understanding of enteral nutrition practices KH f Demonstrate understanding of parenteral nutrition practices KH g Demonstrate understanding of swallowing assessment practices KH h Demonstrate swallowing assessment techniques SH i Demonstrate understanding of counselling theories KH j Demonstrate counselling techniques SH 4.08 Integrate population health promotion principles and approaches a Demonstrate knowledge of determinants of health, health equity and social justice K b Demonstrate knowledge of frameworks for population and public health K c Demonstrate understanding of health promotion KH d Demonstrate understanding of strategies to promote the health of populations KH e Demonstrate understanding of the values and philosophy of public and population health KH Consultation Version Oct-Nov 2019 8
PC / PI GRID Practice Competencies Performance Indicators (PIs) (abilities expected of the dietitian at PI Assessment Required (performance that will be assessed prior to registration) entry-to-practice) Terms in red will be defined in the ICDEP Interpretation Guide Academic1 Practicum1 CDRE2 1 Academic / Practicum assessment coding is based 4.09 Integrate quantity food provision principles and practices on an adapted Miller's pyramid: Demonstrate knowledge of processes for purchasing, receiving, storage, inventory control a K K = Knows; KH = Knows How and disposal of food b Demonstrate knowledge of facility layout and equipment for food production K SH = Shows How; D = Does 2 c Demonstrate knowledge of food production and distribution procedures K CDRE assessments have not yet been determined d Demonstrate understanding of recipe development and standardization KH e Demonstrate understanding of menu planning KH f Demonstrate knowledge of food provision in emergency planning K g Demonstrate knowledge of approaches to food marketing K Demonstrate understanding of food provision strategies that foster healthy food h KH environments 5. Nutrition Therapy 5.01 Assess nutrition status of individuals a Use appropriate nutrition risk screening strategies KH D b Identify and obtain relevant information KH D c Engage client, family and/or relevant others in assessment KH D d Engage other care providers in assessment KH D e Interpret medical history KH D f Interpret medication data KH D g Interpret complementary and alternative medicine data KH D h Interpret demographic, psycho-social and health behaviour history KH D i Interpret food and nutrient intake data SH D j Interpret anthropometric data SH D k Interpret biochemical data KH D l Interpret results from medical tests and procedures KH D m Interpret information from mealtime / feeding observations KH D n Identify signs and symptoms of nutrient deficiencies or excesses KH D o Interpret nutrition-focused physical findings SH D p Identify chewing, swallowing and feeding problems SH D q Perform calculations to determine nutrition requirements SH D r Determine client nutrition requirements KH D 5.02 Determine nutrition diagnosis a Consolidate assessment findings to identify nutrition problem(s) KH D b Prioritize nutrition problems based on importance and urgency KH D 5.03 Develop nutrition care plan* a Identify nutrition care goals based on diagnosis KH D b Select appropriate nutrition interventions KH D c Select therapeutic diet modifications SH D d Select textural diet modifications SH D e Develop or modify food plans KH D f Determine therapeutic supplementation needs KH D g Design enteral nutrition regimens SH D h Design parenteral nutrition regimens SH D i Identify client learning needs and assets related to food and nutrition KH D j Identify additional resources and support services required KH D 5.04 Implement nutrition care plan* a Implement nutrition interventions D Coordinate implementation of nutrition care plan with client, care providers and relevant b D others c Facilitate nutrition education SH D d Provide nutrition counselling SH D 5.05 Evaluate nutrition care plan* a Select strategies to monitor nutrition care plan KH D b Evaluate client progress in achieving nutrition care goals KH D 5.06 Modify nutrition care plan* when appropriate a Identify factors influencing the effectiveness of nutrition care plan KH D b Modify nutrition care plan KH D * nutrition care plan includes any or all of the following: food / nutrient delivery; nutrition education, nutrition counselling, coordination of nutrition-related supports 6. Health Promotion 6.01 Assess food- and nutrition-related situation of communities and populations Recognize types and sources of information required to assess food and nutrition-related a K situation of communities and populations b Participate in stakeholder engagement in assessment KH D c Access relevant assessment information KH D d Interpret food and nutrition surveillance data KH D e Interpret health status data KH D f Interpret information relating to the determinants of health and health equity KH D g Interpret information related to food systems and food practices KH D Consultation Version Oct-Nov 2019 9
PC / PI GRID Practice Competencies Performance Indicators (PIs) (abilities expected of the dietitian at PI Assessment Required (performance that will be assessed prior to registration) entry-to-practice) Terms in red will be defined in the ICDEP Interpretation Guide Academic1 Practicum1 CDRE2 1 Academic / Practicum assessment coding is based 6.02 Determine food- and nutrition-related issues of communities and populations on an adapted Miller's pyramid: Consolidate assessment findings to identify food- and nutrition-related assets, resources a KH D K = Knows; KH = Knows How and needs b Prioritize issues requiring action KH D SH = Shows How; D = Does 6.03 Develop food- and nutrition-related community / population health plan* 2 CDRE assessments have not yet been determined a Contribute to development of goals and objectives for plan KH D b Identify strategies to meet goals and objectives KH D c Identify required resources and supports KH D d Contribute to development of action plan KH D e Contribute to identification of evaluation strategies KH D 6.04 Implement food- and nutrition-related community / population health plan* a Participate in plan implementation KH D b Participate in stakeholder engagement in plan implementation KH D 6.05 Evaluate food- and nutrition-related community / population health plan* a Participate in monitoring of implementation activities KH D b Contribute to plan evaluation KH D 6.06 Modify food- and nutrition-related community / population health plan* when appropriate Propose adjustments to plan to increase effectiveness or meet modified goals & a KH D objectives * food- and nutrition-related community / population health plan includes any or all of the following: monitoring and evaluation of nutritional health and its physical, political, economic and sociocultural determinants; food systems and public policies influencing diet; promotion of healthy eating, and prevention of nutrition-related diseases 7. Food Provision* 7.01 Determine food provision* requirements of a group / organization a Assess food provision requirements based on client context KH D b Identify environmental factors that may impact food provision KH D c Identify stakeholders to engage in assessment KH D d Identify client needs, resources and assets KH D e Consolidate assessment findings to determine food provision priorities KH D 7.02 Develop food provision* plan a Contribute to development of goals and objectives KH D b Identify approaches to meet goals and objectives KH D c Contribute to development of plan KH D d Contribute to identification of evaluation strategies KH D 7.03 Implement food provision* a Participate in food provision activities KH D 7.04 Evaluate food provision* a Participate in monitoring of food provision activities KH D b Contribute to evaluation of food provision KH D 7.05 Modify food provision* when appropriate Propose adjustments to food provision, to increase effectiveness or meet modified goals a KH D & objectives * food provision is the process of providing food to individuals and groups in contexts such as: institutional (healthcare, educational, carceral, daycare, long term care); community-based (food distribution, gardens, kitchens); recreational (sports activities, entertainment sites, camps); business & commercial (hospitality, restaurants, catering, food & beverage industry including therapeutic products) Consultation Version Oct-Nov 2019 10
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