Feed our future : a pragmatist mixed-methods exploration of individual case management (ICM) placements for dietetic students outside the hospital setting

Abstract

Our aging population and the increase in chronic disease is driving a move towards a consumer-led integrated health care system, with an increased need for interdisciplinary primary health care services. Expanding the settings used for Individual Case Management (ICM) placements from hospitals to primary health care settings could increase placement capacity and may better align with the national health reform and health workforce development agendas. This research aims to (1) explores the experiences of key stakeholders with ICM placements for dietetic students outside the hospital setting; (2) identify Australian tertiary ICM placement practices; (3) explore student dietitians’ development of ICM competencies outside the hospital setting; and (4) support supervisors in their competency-based assessment practices. Methods: Within a pragmatist framework, this research uses mixed-methods, and is conducted over three phases. Phase I presents an evaluative case study of an innovative nonhospital ICM setting; Phase 2 includes: (1) a national online survey with placement coordinators at Australian Universities offering accredited Dietetics programs, and (2) a modified-three round Delphi study with eight experienced clinical supervisors; Phase 3 uses a Design-Based research approach to develop an online program for ICM clinical supervisors in competency-based assessment. Results: Phase 1 demonstrated the potential for a non-hospital ICM placement setting to meet the needs of consumers and exceed expectations, while providing a quality learning experience for student dietitians. In Phase 2 the experienced supervisors agreed that, although most universities are using hospitals for their ICM placements, students could develop and demonstrate entry-level ICM competence in non-hospital settings, with adjustments made for nuanced practice differences. This research highlighted the subjectivity of current assessment practices while also demonstrating how through the sharing of assessments and dialogue supervisors can gain a shared understanding of entry-level performance. Phase 3 described the development of a video-based constructivist online program in competency-based assessment showcasing the potential for online learning to support clinical supervisors to achieve more credible and defensible assessment practices. Conclusion: Non-hospital clinical placement settings can provide appropriate experiences for student dietitians to develop individual case management competence, prepare for the future workforce and support the delivery of healthcare in underserviced settings. This research recommends: (1) universities revisit clinical education curricula and consider the inclusion of non-hospital sites in the ICM placement mix; (2) a mix-methods approach to assessment is adopted with the aim of achieving a more comprehensive and in-depth understanding of the student’s development and demonstration of ICM competence,(2) a constructivist video-based online program is used to support clinical supervisors in their assessment of student-dietitians during ICM placements.

Date of Award	2015
Original language	English
Supervisor	Lauren Williams (Supervisor), Laurie Grealish (Supervisor) & Margaret Jamieson (Supervisor)