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1 from the association The 2010 Commission on Dietetic Registration Entry-Level Dietetics Practice Audit: Distinguishing between Educational Attributes Kevin Sauer, PhD, RD, LD; Brian Ward; Dick Rogers; Charles Mueller, PhD, RD, CNSD; Riva Touger-Decker, PhD, RD, FADA; Elaine Fontenot Molaison, PhD, RD, LD The 2010 Entry-Level Dietetics Practice Audit determined the nature of entry-level practice for registered dietitians (RDs) and dietetic technicians, registered (DTRs). The primary goal of the audit was to provide the profession with quantitative insight about the level and frequency of involvement and perceived risk associated with activity statements of entry-level RDs (EL RDs) and DTRs (EL DTRs) in the first 3 years of practice. The Commission on Dietetic Registration uses the audit results to establish RD and DTR exam content domains while the Commission on Accreditation on Dietetics Education assesses the audit outcomes and accreditation standards for educators. This report summarizes the original methods used and distinguishes between characteristics and activities performed by EL RDs and their educational attributes. METHODS The 2010 practice audit was comprised of 166 activity statements determined and categorized by an expert panel of RDs and DTRs representing multiple and diverse areas of dietetics practice. A mixedmode survey instrument with reminders was then used to collect audit data during June and August The overall response rate for RDs (74%) was a significant improvement from previous audits (n 1,892 EL RDs). Congruent with the initial audit summary report, entry level practice was defined as the first 3 years of practice after. The original report and audit findings (1) provide greater detail on methods and key results. The practice audit measured three quantitative levels of activity including the level and frequency of involvement of each activity in addition to the perceived risk associated with each statement measured. As such, detailed tabulations for each measure of activity at the two levels of education, bachelor s vs master s degrees, did not initially yield clear or meaningful results to logically interpret. Therefore, a gap of at least five percentage points in activity between the levels of education and statistical significance at P 0.05 were used to identify meaningful differences between bachelor s and master s EL RDs for this phase of the audit. In no cases was a gap in points between educational levels and activity more than 12 percentage points. The 2010 Entry-Level Dietetics Practice Audit was developed by the Dietetics Practice Audit Committee of the Commission on Dietetic Registration. Charles Mueller, PhD, RD, CNSD chair; Phyllis A. Allen, MS, RD, LD; Ivonne Anglero, MMSc, RD, LDN; David H. Holben, PhD, RD, LD; Krista N. Jablonski, MS, RD, LDN; Penny E. McConnell, MS, RD, SNS; Elaine F. Molaison, PhD, RD; Meghan E. Nichols, RD, CNSD; Aspen S. Perovich, MS, RD, LD; Leonard Pringle, DTR; Crystal Jun Rivero, RD; Kevin L. Sauer, PhD, RD, LD; Darrin W. Schmidt, DTR; Janet J. Skates, MS, RD, LDN, CNSD, FADA; and Collette Sykes, DTR. Staff leadership was provided by Christine Reidy, RD; Kay Manger-Hague, RD; Ulric Chung, PhD; Esther Myers, PhD, RD, FADA; and Lisa Spence, PhD, RD. Research execution, analysis, and reporting were undertaken by Dick Rogers, senior vice president, and Brian Ward, research manager, Readex Research, Stillwater, MN. Address correspondence to: Charles Mueller, PhD, RD, CNSD, Clinical and Translational Science Center, Weill Cornell Medical College, 1300 York Ave, Box 149, New York, NY cmuelle@med. cornell.edu Copyright 2011 by the American Dietetic Association /$36.00 doi: /j.jada RESULTS Demographic information, including level of work experience, and primary position data cross-tabulated by level of education is provided in Tables 1 and 2 (see pages 1757 and 1758). Overall, 1,110 EL RDs held bachelor s degrees while 735 held master s degrees. The proportion attaining a bachelor s degree at and a master s degree later compared with a master s degree at was 183 to 494 (Table 1). The type of master s degree was not explored for either master s degree option and, among post-rd master s respondents, timing of degree matriculation was also not explored. Therefore, the two groups of master s EL RDs were condensed into one for further statistical comparisons Journal of the AMERICAN DIETETIC ASSOCIATION 2011 by the American Dietetic Association

2 Table 1. Characteristics differing between entry-level registered dietitians (RDs) whose highest degree is a bachelor s vs a master s degree; 2010 Entry-Level Dietetics Practice Audit Bachelor s RDs with bachelor s degrees tended to be younger (Table 1) than those with master s degrees. Data in Tables 2 to 4 (see pages 1758 through 1761) represent respondents who were practicing in dietetics. Significant differences in primary practice areas between RDs having bachelor s vs master s degrees were observed in clinical nutrition acute-care inpatient (49% bachelor s vs 41% master s) and consultation and business (7% bachelor s vs 13% master s) (Table 2, see page 1758). Nutrition care also represented the practice area and practice setting wherein a higher proportion of bachelor s EL RDs spent their time (at least 20% or more) compared with EL RDs who had master s degrees. In contrast, a greater proportion of EL RDs with master s degrees were involved in research/teaching than EL RDs with bachelor s degrees. EL RDs with bachelor s degrees were more likely to spend their time in acute-care inpatient settings than EL RDs with master s degrees. However, the opposite was the case for college/university/teaching-hospital faculty and private practice settings. More often, was required for employment for EL RDs with bachelor s degrees (87% vs 77%) than their counterparts with master s degrees. Master s Master s, master s later n 1, Location (census division) East North Central 20% 13%* 9% 15%* Other 80% 87%* 91% 85%* Nondietetics work experience prior to Some 50% 58%* 56% 59% None 49% 42%* 44% 41% Age (y) 40 or older 8% 9% 8% 8% % 6% 3% 7% % 21%* 13% 24%* % 57% 65% 56%* Under 25 13% 5%* 9% 4%* Mean * * *Difference statistically significant at P 0.05 or better and at least 5 points different (if percentages compared). Practice audit activities reported by more EL RDs with bachelor s than with master s degrees were situated within the practice areas of managing human resources, managing food and other material resources, and providing nutrition care either generally, in the community, and/or to individuals (Table 3, see pages 1759 and 1760). Generally, activities reported more often by EL RDs with master s degrees were more concentrated in the practice areas of conducting research, writing business and strategic plans, and marketing of products, programs, or services. In addition, EL RDs with master s degrees were more involved with providing nutrition programs for population groups than their counterparts with bachelor s degrees (Table 4, see page 1761). IMPLICATIONS AND CONCLUSION This report identifies some differences in entry-level practice between EL RDs with bachelor s and those with master s degrees. These data are likely of value to many stakeholders involved in dietetics practice and education, as well as to organizational units exploring levels of practice and educational requirements. The preliminary findings provide evidence that further research focused on differences in timing and type of graduate degrees and practice is needed (2). The 2010 audit could not attribute differences in entry-level practice based solely on level of education attained. The audit was devised to identify entry-level activity as the central theme and mission. As such, activities and practices that might be identified specific to having a graduate degree were not included in the audit. Types of graduate degrees as well as focus areas (ie, relative to dietetics or a prior career) were likewise not explored and, hence, limit interpretation of findings. Future research would be needed to identify these activities in relation to timing and type of graduate degrees. The results and lack of significant distinctions between bachelor s and master s degree levels of educational preparation also do not imply that graduate and advanced degrees or education are not important to the profession. Commission on Accreditation for Dietetics Education standards focus on entry-level practice competence and, hence, do not distinguish between graduate and undergraduate competencies. Therefore, significant differences between educational preparation and entry-level practice would not be expected from an audit focused solely on entry-level practice. The findings presented in this report do support the need for future research, especially in regard to entrylevel practice and the attainment, type, and related timing of graduate degrees to distinguish between entry and post-professional graduate degrees. References 1. Ward B, Rogers D, Mueller C, Touger-Decker R, Sauer KL. Entry-level dietetics practice today: Results from the 2010 Commission on Dietetic Registration Entry-Level Dietetics Practice Audit. J Am Diet Assoc. 2011;111: Rigby-Koutz J, Touger-Decker R, Brody R, Rigassio-Radler D, Khan H, Byham-Gray L, O Sullivan Maillet J. The perceived benefits of master s degrees in two samples of registered dietitians. Top Clin Nutr. 2010;25: November 2011 Journal of the AMERICAN DIETETIC ASSOCIATION 1757

3 Table 2. Primary position characteristics differing between practicing entry-level registered dietitians (RDs) whose highest degree is a bachelor s vs a master s; 2010 Entry-Level Dietetics Practice Audit Bachelor s Master s Master s, n 1, Practice area of primary position Clinical Nutrition Acute Care/Inpatient 49% 41%* 43% 40% Clinical Nutrition Ambulatory Care 11% 11% 8% 12% Clinical Nutrition Long-Term Care 12% 8% 9% 7% Community 13% 12% 12% 13% Consultation and Business 7% 13%* 11% 13% Food and Nutrition Management 4% 4% 4% 4% Education and Research 1% 6% 9% 5% Other 2% 4% 3% 4% Registration requirement Registration as an RD is required for employment in position 87% 77%* 75% 78% Registration is preferred but not required 10% 16%* 17% 15% Registration makes no difference 3% 6% 8% 6% Practice area(s) where at least 20% of time is spent Nutrition care/counseling for individuals 86% 76%* 78% 76% Nutrition information/education for groups 42% 43% 44% 43% Foodservice 17% 12%* 13% 12% Organizational (not functional) administration/management 14% 17% 19% 16% Research/teaching 11% 18%* 20% 18% Sales, marketing, product development, communications, 6% 12%* 10% 12% public relations Others Setting(s) where at least 20% of time is spent Acute-care facility inpatient 47% 38%* 37% 39% Acute-care facility outpatient 17% 14% 13% 14% Community or public health program 14% 16% 17% 15% Long-term or extended care facility 15% 11% 12% 11% Ambulatory/outpatient care facility 9% 9% 10% 10% Rehabilitation facility 8% 6% 5% 7% College, university, or teaching-hospital faculty 4% 10%* 12% 9% Government agency or department 6% 6% 6% 7% Private practice 3% 9%* 7% 8% Wellness center or health club 5% 5% 5% 5% Others *Difference statistically significant at P 0.05 or better and at least 5 points different November 2011 Volume 111 Number 11

4 Table 3. Activities where the percentage involved is greater for practicing entry-level registered dietitians (RDs) whose highest degree is a bachelor s than for those with a master s; 2010 Entry-Level Dietetics Practice Audit No. Activity Bachelor s Master s Master s, n 1, General 4 Collect data for clinical and/or management decisions 58% 53%* 53% 53% 10 Implement electronic management of food delivery and health-care 44% 38%* 40% 37% services (eg, electronic health records) 11 Use health-care informatics systems/technologies 52% 45%* 46% 45% Principles of education Conducting research Managing human resources 37 Conduct staff orientation, training, in-service, or staff development programs 42% 36%* 39% 36% Marketing of products, programs, or services Managing food and other material resources 62 Maintain safety and sanitation of food, facilities, or equipment 30% 23%* 23% 23% 65 Develop menus for clients with special or therapeutic needs 43% 36%* 36% 36% 68 Check trays for accuracy 30% 25%* 27% 25% 73 Monitor food quality 35% 29%* 30% 29% 74 Evaluate food products using sensory techniques such as taste, 37% 27%* 30% 26% smell, and appearance Managing facilities Managing financial resources Providing nutrition care community/clinical general 104 Nutrition Care Process: Screen 83% 72%* 71% 73% 105 Nutrition Care Process: Assess 88% 78%* 77% 79% 106 Nutrition Care Process: Diagnose nutrition problems 84% 76%* 73% 78% 107 Nutrition Care Process: Intervene 87% 78%* 76% 79% 108 Nutrition Care Process: Monitor 88% 77%* 76% 77% 109 Nutrition Care Process: Evaluate 87% 76%* 75% 77% 110 Counsel clients and their families 88% 80%* 83% 80% 111 Counsel on end-of-life issues related to nutrition and hydration 48% 40%* 37% 42% 112 Recommend clients receive physical, social, behavioral, or 72% 66%* 66% 68% psychological services Providing nutrition care to individuals 114 Take diet histories 86% 77%* 76% 78% 116 Evaluate anthropometric measurements 84% 76%* 76% 77% 120 Review medical records for information including nutrition-related 83% 73%* 75% 72% data 121 Evaluate influence of psychological status on eating behaviors 77% 71%* 71% 70% 122 Evaluate eating habits, patterns, and choices of clients 88% 81%* 82% 80% 123 Compare lab results to normal values 87% 78%* 76% 78% 124 Calculate nutrient requirements 85% 76%* 72% 77% 125 Calculate fluid requirements 78% 67%* 66% 66% 127 Calculate nutrition intakes (eg, calorie count) 77% 70%* 67% 72% 128 Evaluate intake of specific nutrients 77% 71%* 73% 70% 129 Recommend nutrition status lab tests 72% 66%* 64% 66% 131 Evaluate and monitor medications 65% 57% 54% 58% 132 Help patients/residents with daily menu selection 57% 49%* 47% 50% 133 Adapt regular oral diets to meet individual preferences or needs 73% 63%* 61% 63% 134 Plan oral diets with multiple nutritional requirements 65% 59%* 61% 58% 135 Recommend diets 83% 73%* 72% 75% 136 Recommend nutritional supplements for clients on oral diets 81% 70%* 70% 71% (continued) November 2011 Journal of the AMERICAN DIETETIC ASSOCIATION 1759

5 Table 3. Activities where the percentage involved is greater for practicing entry-level registered dietitians (RDs) whose highest degree is a bachelor s than for those with a master s; 2010 Entry-Level Dietetics Practice Audit (continued) No. Activity Bachelor s Master s Master s, 139 Recommend tube feeding therapies 63% 52%* 52% 52% 142 Recommend intravenous or parenteral nutrition 50% 41%* 37% 43% therapies 144 Refer clients to community resources for ongoing 53% 46%* 48% 47% services, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or home-delivered meals 145 Assess needs and identify resources for ongoing 57% 48%* 46% 48% nutrition care such as nutrition counseling or home 146 Recommend medications 47% 39%* 37% 41% 148 Document client care 78% 70%* 70% 70% 149 Present patients at rounds 37% 31%* 29% 32% 150 Participate in decision-making with a health-care 71% 62%* 59% 63% team 151 Evaluate intake and output (I/Os) 55% 47%* 49% 47% 152 Evaluate clients overall health status (eg, physical 73% 65%* 63% 65% and clinical conditions, and physiological and disease status) 154 Evaluate tolerance of diet, tube feeding, and 73% 61%* 62% 60% supplements 155 Evaluate tolerance of parenteral nutrition 50% 39%* 34% 41% Providing nutrition programs for population groups *Differences statistically significant at P 0.05 or better and at least 5 points different November 2011 Volume 111 Number 11

6 Table 4. Activities where the percentage involved is greater for practicing entry-level registered dietitians (RDs) whose highest degree is a master s than for those with a bachelor s; 2010 Entry-Level Dietetics Practice Audit No. Activity Bachelor s Master s Master s, n 1, General 2 Adapt products, programs, or services to fit the market 42% 50%* 45% 52% 3 Collect data used in research studies 21% 29%* 36% 28%* 5 Evaluate and synthesize research literature using a formal method 14% 27%* 29% 26% 7 Write reports 33% 39%* 42% 37% 14 Develop a business plan for a product, program, or service 13% 20%* 15% 21% 15 Develop strategic plan for your organization 23% 30%* 30% 29% Principles of education Conducting research 25 Review research literature 50% 58%* 62% 60% 29 Conduct research studies 5% 10%* 15% 9%* 30 Report research at professional conferences 3% 9%* 11% 9% 31 Write manuscripts for peer-reviewed publications 2% 8%* 11% 7% Managing human resources Marketing of products, programs, or services 49 Develop marketing objectives or strategies for products, 13% 20%* 19% 20% programs, or services 50 Define target markets for products, programs, or services 14% 20%* 17% 20% 51 Develop new products, programs, or services 19% 26%* 25% 26% 52 Develop promotional materials describing products, programs, or 21% 30%* 33% 28% services 56 Implement marketing plan 7% 13%* 9% 13% Managing food and other material resources Managing facilities Managing financial resources Providing nutrition care community/clinical general Providing nutrition care to individuals Providing nutrition programs for population groups 159 Identify nutrition-related problems within population groups 19% 24%* 25% 23% 160 Collect data on community resources 9% 15%* 12% 16% 161 Design services to meet nutrition-related needs of populations 16% 24%* 26% 23% 165 Provide fitness education 21% 28%* 27% 29% 166 Serve as a resource for community organizations 27% 32%* 30% 32% *Differences statistically significant at P 0.05 or better and at least 5 points different. November 2011 Journal of the AMERICAN DIETETIC ASSOCIATION 1761

A Comparison of Job Responsibility and Activities between Registered Dietitians with a Bachelor's Degree and Those with a Master's Degree

Florida International University FIU Digital Commons FIU Electronic Theses and Dissertations University Graduate School 11-17-2010 A Comparison of Job Responsibility and Activities between Registered Dietitians