Assessment Method 1: Case Study in Medical Nutrition - Endocrinology
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1 Assessment Report Program: Dietetics, BS College of Human Sciences Nutrition, Dietetics & Hospitality Management Dietetics, BS Expected Outcome 1: Competency in Clinical Nutrition/Nutrition Care Process Clinical Nutrition The student will be able to apply the principles of medical nutrition therapy and the nutrition care process, including principles and methods of assessment, diagnosis, identification and implementation of interventions and strategies for monitoring and evaluation. (ACEND Standard KRD 3.1) Student Leaning Outcome The student will implement the nutrition care process, including nutrition assessments, formulation of nutrition diagnosis, interventions, and ongoing evaluations of patients through case-study simulations documented in the form of an ADIME note. ADIME is a common medical record entry format. Assessment Method 1: Case Study in Medical Nutrition - Endocrinology Assessment Method Description Students are assigned a comprehensive case study in NTRI 5020/6020 Medical Nutrition I with questions covering all aspects of the nutrition care process. To further assess competence in the nutrition care process including nutrition assessment, nutrition diagnosis, intervention, monitoring and evaluation students document the case in the form of an ADIME note. An assessment of analysis and patient education components is also included in the student learning outcome assessment. An endocrine case, specifically diabetes mellitus was used for this assessment. The rubric, enclosed in Appendix A is used for several cases within the two-semester medical nutrition series and can be used to track student improvement in the various domains over the course of the senior year. Findings The mean for the ADIME note assignments 20.65/25 possible points or approximately an 80% was achieved on the first ADIME assessment of the 2- semester course. The weakest area was nutrition diagnosis (2.87/5 possible points). Students had difficulty using appropriate PES statements (problem, 1
2 etiology, and signs/symptoms) to make a diagnosis in standard format used by most acute and ambulatory health care facilities. The most significant problem here was that students often made a medical diagnosis. The strongest domain was patient education where students received a 2.67/3 possible points. There were several class sessions and case components dedicated to patient education a critical component of diabetes management. How did you use findings for improvement? Given that students struggled with the Nutrition Diagnosis and PES statements it was somewhat apparent that many were not using the standard statements provided in the text. The instructor redirected students to the standard statements, referred students to the on-line Nutrition Care Manual on the Academy of Nutrition and Dietetics website, and incorporated sample diagnostic statements in subsequent lectures for various other disease states (e.g., hypertension, liver disease and obesity). In addition, a lecture/group workshop session was added to NTRI 5030/6030 Medical Nutrition II to allow students to work through diagnostic statements with the assistance of the course instructor. Students were given multiple cases over the course of the two semester series and evaluated using the same rubric. On the last ADIME note the scores in the diagnostic area improved from a mean of 2.87 (averagemeets expectations) to a mean of 3.86 (above expectations-excellent) out of 5. Additional Comments 2
3 Expected Outcome 2: Dietetics Practice Competency Practice Competency Graduates will be prepared for entry-level practice emphasizing foundation knowledge and competency in nutrition and dietetics (DPD Program Goal 1) Student Learning Outcome The mean exam scores of program graduates of the Auburn University Didactic Program in Dietetics (DPD) will exceed the national mean on the Registration Examination for Dietitians in each of the following areas: total scaled score, nutrition domain, and food service domain. Assessment Method 1: Registration Examination for Dietitians (External Assessment) Assessment Method Description Background - In order to become a registered dietitian DPD graduates must complete a supervised practice experience and take the National Registration Examination for Dietitians. The exam is comprehensive and tests all Knowledge Requirements for the Registered Dietitian (KRDs) required to be taught in the DPD curriculum by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) of the Academy of Nutrition and Dietetics. The exam is administered through the Commission and Dietetic Registration (CDR) (contracted with ACT). ACT provides the DPD Program Director with an Institutional Report for Auburn graduates twice a year. In addition, CDR provides a 5-year exam Summary Report of Auburn graduates once a year. Statistics provided by the administrators of the National Examination for Registered Dietitians include comparisons of Auburn s candidates' mean test scores to mean national scores. Findings For Auburn students taking the National Registration Examination for Dietitians mean total scaled scores and scores on each domain exceeded the national mean. Student performance met the student learning outcome goal. 3
4 How did you use findings for improvement? While the AU DPD student learning outcome goal was met, it is worth noting that we are only slightly above the national mean on all three measures: total scaled score, nutrition, and food service. The program is currently conducting a self-study for continuing accreditation by ACEND, reviewing all aspects of the curriculum, and are in the process of implementing a number of curriculum/course revisions to better address the KRD standards. 4
5 Expected Outcome 3: Support Knowledge - Macronutrient Metabolism Nutrient Metabolism Students will demonstrate knowledge of the physical and biological science foundation of the dietetics profession including digestion, absorption and metabolism of nutrients. (ACEND Standard KRD 5.1) Student Learning Outcome The student will demonstrate knowledge of the digestion, absorption and metabolism of the major nutrients including proteins, carbohydrates, and lipids. Assessment Method 1: NTRI 4020 Macronutrients Course Exams Assessment Method Description Assessment of student learning outcomes was evaluated using 4 semester exams in NTRI 4820 Metabolism for Spring Questions from three one-hour midterm exams and the final exams were used for the SLO assessment. Each of the questions were identified as relating to the following topics: carbohydrate digestion, carbohydrate absorption, and carbohydrate metabolism; lipid digestion, lipid absorption, and lipid metabolism; and protein digestion, protein absorption, and protein metabolism. A total of 41 NTDI students were assessed during the Spring semester Question distribution for the various topics were as follows: 13 questions for carbohydrate digestion, 12 questions for carbohydrate absorption, and 25 questions for carbohydrate metabolism; 9 questions for lipid digestion, 8 questions for lipid absorption, and 28 questions for lipid metabolism; and 7 questions for protein digestion, 5 questions for protein absorption, and 23 questions for protein metabolism. Findings A total of 41 NTDI-DPD students were assessed during the Spring semester 2014 (see attached table - Support Knowledge: Digestion, Absorption, and Metabolism - NTRI 4820 Macronutrients). Analysis of data indicates that student performance was strongest with regard to digestion of nutrients including proteins, carbohydrates, and lipids. Correct responses ranged from 81.6% to 90.2%. Performance was relatively strong with regard to macronutrient absorption with response percentages ranging from 75.8% to 92%. The weakness aspect of the students performance was in the area of metabolism for all of the macronutrients analyzed. Correct response percentage ranged from 55.4% to 70.6% with an overall mean of 61.2%. The carbohydrate and lipid components were the weakest area with a score of 55.4% and 57.5%, respectively. In terms of overall correct response percentage for the macronutrients combining all subject matter (digestion, absorption, and metabolism), the students performance was weakest for the lipids and carbohydrates components (correct response percentage = 74 and 74.3%, respectively). 5
6 How did you use findings for improvement? Based on the assessment outcome provided above, we have found that the NTDI students scored the lowest on metabolism based questions overall, and had particular trouble with the subject matter dealing with carbohydrate and lipid metabolism. For next year s course, we will implement learning activities in the form of case studies that will focus on metabolism of the macronutrients to address specific aspects of this learning outcome. These case studies will be designed to enhance the comprehension of applied aspects of metabolism within this course. Since a majority of the metabolism questions on the exams require integration of the students knowledge of metabolism, these assignments will enhance the overall learning environment for the students through application. Specific rubrics will be designed to objectively grade and assess these learning outcomes. In addition, learning outcomes will continue to be assessed via exams as described above. In addition, a comparative assessment of the prerequisite course BCHE 3180 Nutritional Biochemistry will be assessed. BCHE 3180 deals with similar topics in nutrient metabolism. It will be beneficial to address assessment of metabolism in this course to determine if poor performance with regard to acquisition of requisite knowledge carries over. Additional Comments 6
7 Appendix A. Auburn University Didactic Program in Dietetics ADIME Note Guidelines and Rubric Content Excellent (4pts) Meets Expectations (3) Below Expectations (2) Unsatisfactory (1) DATE AND TIME Assessment All pertinent components documented without error. Captures essence of patient history and current problem. Accurately summarizes most of pertinent information. Missing components. Includes irrelevant information. Multiple missing components. Information belongs in another section. Comments/Points Diagnosis (nutrition) Uses appropriate PES statement (s) c/w nutrition care process. Statements accurately prioritized. No more than one element missing. Not written in PES statement format or standardized. Medical diagnosis listed as nutrition diagnosis. Missing one or more PES. Not written in PES statement format or standardized. Medical diagnosis listed as nutrition diagnosis. Comments/Points Interventions Appropriate and specific plans. Implementation to remedy nutrition diagnosis documented. Vague plans and/or implementation. Missing plans or implementation. Intervention not parallel to nutrition diagnosis. MDs orders documented as intervention; inappropriate plan or intervention. Comments/Points Monitoring/ Evaluation SIGNATURE and CREDENTIALS (dietetic student) Appropriate nutrition care outcomes relative to nutrition diagnosis, intervention plans, and goals. Nutrition care outcomes defined, specific indicators identified. No more than one missing item. 7 Nutrition care outcome not relevant to nutrition diagnosis, intervention, or goals. Nutrition care outcomes cannot be measured or compared to established criteria. Incomplete. Missing multiple elements; not c/w diagnosis, plan or care, goals; evaluation not present or measurable.
8 Comments/Points SEE OTHER SIDE: Writing Points Comments Spelling / Grammar /1 Appropriate use of medical terminology /2 Analysis (BELOW) Points Comments Interventions supported by assessment and nutrition diagnosis (below) /3 Patient Education /3 Total Points /25 Describe here how you arrived at your nutrition intervention(s). What is the rationale behind your recommendations? 8
9 Identify three specific nutrition-related patient education points. Feel free to use a bullet list. PLEASE TURN IN THIS SHEET WITH YOUR ADIME NOTE ATTACHED! 9
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