text: jeehp-17-40.pdf
  Elizabeth MacQuillan, Jennifer Ford, Kristin Baird
  MacQuillan, Ford, Baird, and Huh: Increased competency of registered dietitian nutritionists in physical examination skills after simulation-based education in the United States
  J Educ Eval Health Prof 2020; 17: 40. https://doi.org/10.3352/jeehp.2020.17.40
  Elizabeth MacQuillan * , Jennifer Ford , Kristin Baird
  Received November 5, 2020 Accepted December 12, 2020 Published online December 14, 2020
  NFPE skills were assessed by reviewing video recordings of the SP encounters. Recordings were made accessible to the researchers through an encrypted website for the purpose of assigning a competence score. The instrument used to assess competence from the video encounters was developed based on evidence-based practice guidelines for clinical competence assessment and using the guidelines of the Academy of Nutrition and Dietetics for Nutrition-Focused Physical Exam [10,11]. The tool is comprised of 7 competencies (1: approach to patient; 2: micronutrient deficiency/excess; 3: head/face; 4: upper body; 5: lower body; 6: abdominal exam; 7: functional status assessment) broken into performance indicators with criteria statements to aid raters in scoring performance on a 9-point scale. The instrument, developed by these authors, has demonstrated excellent content validity, inter-rater reliability, and internal consistency in standardization testing. For content validity, a total of 7 expert dietetics educators and clinical managers rated the NFPE competency assessment tool on a 4-point relevance scale. The item content validity index scores calculated for each of the 7 competencies assessed by the tool ranged from 0.86 to 1.00, indicating excellent relevance of items on the scoring tool. When ratings on all 7 competencies, at both the pre- and post-training time points, were assessed by 3 raters viewing the same recordings, the overall Fleiss kappa results based on a total of 140 observations indicated extremely strong agreement (κ=0.863; 95% confidence interval [CI], 0.860-0.866; P<0.001). When scores for each competency were considered individually and assessed for agreement between the 3 raters, the Fleiss kappa results again confirmed excellent agreement, with competency-specific scores ranged from κ=0.726 for competency 7 to κ=1.00 for competency 6. The relatedness of scores among the 7 competencies were analyzed by calculating the inter-class correlation coefficient (ICC) for the competencies (ICC, 0.913; 95% CI, 0.879-0.940; P<0.001). Additionally, the Cronbach alpha statistic was calculated for the 7 competencies, with the result of α=0.913, indicating excellent internal consistency between items. The competency scoring instrument can be viewed in Supplement 1.
  Variables such as time in practice, highest educational degree earned, and frequency of using NFPE in practice were considered in the analyses in order to detect any effects on competence. Statistical analyses conducted in IBM SPSS ver. 25.0 (IBM Corp., Armonk, NY, USA) included: first, descriptive statistics of the subject population; second, the percent of RDNs competent at the initial time point; third, the change in competence scores following remediation training, with mean competence scores compared using the paired t-test; and fourth, analysis of variance (ANOVA) to determine whether the analyzed variables (length of time in practice, education level, and area of practice) were associated with significant differences in mean competence scores from the initial assessment to the post-training re-assessment. For analyses, scores were considered both on the 9-point scale and categorically, in 3 levels. Categories were considered to better indicate the clinically relevant groups of "below expectations" (scores of 1-3), "meets expectations" (scores of 4-6), and "exceeds expectations" (scores of 7-9). For a binary analysis of initial competence, scores within the category of "meets" or "exceeds" expectations were considered as "competent." These categorical outcome analyses were included in order to identify differences in NFPE skills that would be relevant and meaningful in the professional health care setting.
  The subjects included 18 RDNs employed at Spectrum Health, a private health system in the Midwest region of the United States. All 18 participants attended the 90-minute training and completed both pre- and post-training NFPE assessments. The raw data file is available in Dataset 1 and 2.
  The mean number of years in practice as an RDN for the participants was 9.6 years (standard deviation=7.7). Most participants (n=13, 72.2%) had earned a bachelor's degree as their highest earned degree. The largest category reported for the average number of times performing NFPE in a week was 15 or more times per week (n=8, 44.4%), followed by 8-14 times (n=4, 22.2%). The complete results of the survey are shown in Table 1.
  When competence scores on the 9-point scale were assessed for changes from pre- to post-SBE training, significant increases in competence scores were observed in all 7 competency areas. The greatest increase in competence scores among the RDN participants occurred in competency 6 (abdominal exam), with a mean increase of 3.72 points (95% CI, 3.12-4.26), followed by competency 7 (functional status assessment; mean increase, 3.31; 95% CI, 2.69-3.93). The smallest increase from before to after training occurred in competency 1 (approach to the patient; mean increase, 1.27; 95% CI, 0.73-1.81). Further investigation into the significance of differences between mean scores at the pre-training and post-training time points using the paired t-test revealed significant increases in all 7 competency areas following the simulation-based training (P<0.001). In terms of the binary distinction between "meets expectations" and "below expectations," across all 7 competencies, on average 15 out of the 18 participants (83.3%) scored as competent following the SBE training. Complete results of the competency score change and the paired t-test are shown in Table 3.
  Based on the competence change results (Table 3), it appears that simulation-based training was an effective method for teaching these skills, and participants achieved a mean score following the training that was within the range of competence. The simulation-based training provided in this study produced significant increases in all 7 competencies and, for the 6 competencies where participants scored "below expectations" prior to training (competencies 2-7), the post-training scores fell within the range of competence (scores between 4 and 6, equivalent to "meets expectations").
  Conceptualization: EM, KB, JF. Data curation: EM, KB, JF. Formal analysis: EM. Funding acquisition: none. Methodology: EM, JF, KB. Project administration: EM. Visualization: none. Writing-original draft: EM. Writing-review & editing: EM, JF, KB.
  jeehp-17-40-dataset1.xlsx
  jeehp-17-40-dataset2.xlsx
  jeehp-17-40-suppl1.pdf
  jeehp-17-40-abstract-recording.avi
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  1-4 8 (44.4)
  5-9 2 (11.1)
  10-19 5 (27.8)
  0-2 3 (16.7)
  3-7 3 (16.7)
  8-14 4 (22.2)
  a) Competence scores based on a 9-point scale, where 1-3=below expectations, 4-6=meets expectations, and 7-9=exceeds expectations.
  Mean difference (post-test-pre-test score)
  1: Approach to patient 5.21±0.82 1.27 (0.73-1.81) 4.94 (17) 0.001
  2: Micronutrient deficiency/excess 4.52±1.03 2.00 (1.41-2.49) 8.64 (17) <0.001
  3: Head/face 4.97±0.95 1.81 (1.10-2.51) 5.41 (17) <0.001
  4: Upper body 4.75±1.13 1.75 (1.13-2.37) 5.99 (17) <0.001
  5: Lower body 4.00±1.55 1.47 (0.79-2.15) 4.61 (17) <0.001
  6: Abdominal exam 4.83±0.99 3.72 (3.19-4.26) 14.7 (17) <0.001
  7: Functional status assessment 5.11±0.82 3.31 (2.69-3.93) 11.2 (17) <0.001
  Effects of an integrated geriatric group balance class within an entry-level Doctorate of Physical Therapy program on students' perceptions of geriatrics and geriatric education in the United States2016 ;13