Educational perspectives of British Columbia dietitians: uncovering educational beliefs

Most dietitians assume they know how to teach and educate because they are content experts. Most also assume that the process of teaching is equated with techniques, skills, and methods. Teaching techniques and skills are important; however, they do not represent the entire educational process. Educational beliefs are paramount and shape what dietitians say, do, and how they interact with their clients. Currently, only limited conceptual frameworks on teaching and education exist within dietetics. In this study, the five Educational Perspectives and general model of teaching developed by Pratt (1998) were used as conceptual frameworks to examine the educational beliefs of dietitians. An equally important goal was to reveal professional interests, roles and responsibilities, educational backgrounds and experiences, teaching influences, and international education and work experience - topics which have not been investigated on a large scale but which provide information on the interests and characteristics of dietitians. The study was also designed to determine if relationships existed between personal, professional and social-cultural characteristics and the five Educational Perspectives. To meet the research goals, a quantitative mail-out survey named the Educational Perspectives of Registered Dietitians was sent to 483 dietitians throughout British Columbia. Two hundred and forty or just over half of the total sample frame returned surveys and were analyzed using SPSS. Data from closed-ended questions were analyzed using frequency tabulations and other univariate statistical procedures to summarize demographic, work, and professional characteristics. Then correlational analyses tested for relationships between the educational perspectives and personal, professional and social-cultural characteristics. Open-ended questions were initially alphabetized using SPSS and were then thematically analyzed by the researcher. Results of the survey revealed that the vast majority of respondents were female, most were in their early thirties to late forties, over half had children, and the large majority were native speakers of English. A relatively small number of respondents had obtained Bachelor degrees outside of dietetics. Less than one-quarter of respondents had obtained or were in the process of obtaining graduate degrees, but a slightly greater number of respondents had either obtained or were in the process of obtaining certificates or diplomas. Most degrees were science or nutrition oriented and most certificates reflected either management or clinical specialties. Less than one-quarter of these dietitians had received some schooling outside of Canada in coursework that was taught mainly in English; a relatively small number of respondents had worked as dietitians outside of Canada. A small number of respondents had previous careers prior to dietetics. Respondents had practiced dietetics for an average of about fourteen years; and less than half worked full-time. Dietitians interact with many different types of people but the majority work in traditional health care settings. Over half of respondents are responsible for nutrition counseling and teaching. The majority of dietitians valued the relationship of nutrition to health, helping others and working with health care team. At the outset of their careers, most respondents were initially interested in nutrition counseling and behavior change, health promotion, nutritional sciences and teaching; but over time respondents became more interested in research, management and food production, cultural food habits and entrepreneurial activities. The number of their professional interests increased by about a third over time and the increase was statistically significant. Other people - particularly colleagues, influenced the majority of dietitians' teaching practices. In terms of their Educational Perspectives, dietitians were most dominant in Nurturing, followed closely by Apprenticeship, Transmission, then to a smaller degree Developmental and to a very small degree, Social Reform. Forty-eight dietitians were dominant in two Educational Perspectives; Nurturing and Apprenticeship or Apprenticeship and Transmission. When dietitians' Educational Perspective scores were compared to groups of 414 other professionals, dietitians were less Nurturing and Developmental oriented, were more Transmission oriented, and slightly less Social Reform. Except for Apprenticeship, the small differences in scores were statistically significant. Although the difference in Apprenticeship Perspective scores between the two groups was not significant, they represented the highest scores for both groups. There were thirty-five significant correlations between personal and professional variables and the five Educational Perspectives. Three significant correlations characterized dietitians high on Transmission: attending school in a country outside of Canada, valuing management opportunities within dietetics, and feeling that university coursework had influenced their teaching practices. Two significant correlations characterized dietitians high on Apprenticeship: possessing graduate degrees and feeling that university coursework had influenced their teaching practices. Eight significant correlations characterized dietitians high on Developmental: practicing dietetics over a longer period of time, expressing an initial interest in teaching within dietetics and in managing people and resources, interacting with community groups, marketing, being involved with public and media relations, and interacting with community groups and the public. Another eight significant correlations characterized dietitians high on Nurturing: expressing an initial interest in teaching, interacting with community groups, being involved with public and media relations, and feeling that workshops and seminars, authors, colleagues, teachers of education, and authors on educational topics had influenced their teaching practices. Fourteen significant correlations characterized dietitians high on Social Reform: speaking languages other than English (initially fluent and currently speaking languages other than English, and currently speaking more than one language), practicing dietetics over a longer period of time, expressing an initial interest in cultural food habits, managing people and food production, expressing a current interest in managing people, interacting with the general public, community groups, being involved with public and media relations, feeling that activities or other people influenced teaching practices, and being less responsible for nutrition counseling and one-to-one interactions with patients. Although they were offered the opportunity for feedback, less than one-half of respondents requested that an Educational Perspectives Inventory Profile sheet be mailed back to them. Respondents who requested a profile sheet were generally no different from the other respondents who did not request feedback. There were no significant correlations between respondents who requested an educational profile and the five Educational Perspectives. However, in terms of their work-related characteristics, people requesting feedback had been attracted by a wider range of potential features of the profession. It was surprising to discover the degree of importance that dietitians attributed to measurable behavioral change. Generally, dietitians attributed lack of change as a result of deficiencies in clients (lack of compliance, interest, or motivation) rather than other factors such as dietitians' approaches or attitudes about learning and education or challenges associated with the learning contexts. Another surprise was the extent that dietetic colleagues influence each other's teaching practices. There are several recommendations from this study: dietitians need to constantly re-examine undergraduate and internship educational competencies to encourage future dietitians to critically analyze their roles as educators; formation of an Adult Education Practice Group; member forums on educational and teaching issues; development of online education discussion groups; and continuing education activities on the roles of dietitians as educators and teachers. The five Educational Perspectives and general model of teaching were used as theoretical tools to help reveal assumptions about dietitians and their learners, content, context, and beliefs about knowledge and learning. Additionally, information about personal and professional characteristics of dietitians was obtained which can be used to create a database and monitor trends and interests. Dietitians are health professionals who work in different settings, interact with different clientele, and who accumulate a unique body of knowledge based on their education, training, and experience. Although differences exist among individual dietitians, there is one unifying thread. Dietitians are teachers and educators.

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