The transition from dietetic intern to registered dietitian involves a tremendous amount of adaptation over a relatively short time. Interns must acquire the knowledge, practical skills, and critical thinking processes that underpin dietetic practice. In addition, interns must move through a socialization process where they internalize the values, attitudes and behaviours that define how dietitians conduct themselves in the workplace.
Evidence suggests that student nurses, medical interns and other trainees (including dietetic interns) experience ’Transition Shock’ (Duchscher, 2008) and struggle with feelings of anxiety, insecurity, inadequacy and instability as they move from the known role of student to the less familiar role of health care practitioner (Kramer, 1974; Duchscher, 2008). Simulations have been identified as a strategy to combat Transition Shock, and can be used to provide a skills-based clinical experience in a safe and secure environment (Fowler-Durham and Alden, 2007). Exposing students to activities that mimic those occurring during practicum training is thought to decrease anxiety and promote skill development.
Role the tape!
In September 2008, simulation suites based at the University of Alberta (UA) Health Sciences Education and Research Commons (HSERC) began operations. The suites, constructed to resemble clinical interview or examination rooms, allow students to be discreetly videotaped while engaged in practice-based activities with mock patients. The process used to tape simulated patient care activities at the HSERC is novel. While both the student and the mock patient consent to being videotaped, they have limited awareness of a camera in the room as cameras are disguised as light fixtures and controlled by a teaching assistant from a hidden monitoring room. Video footage of the simulation is saved to a secure website that students can access. Students can only access their own footage. They can do this from home if they wish and can view the footage repeatedly to identify strengths and areas for skill development.
The first cohort of dietetic interns participated in simulated patient interviews in the Winter of 2009. The simulations were structured to expand on a basic nutrition assessment and interviewing framework taught in NUTR 466: Introduction to Professional Practice. NUTR 466 is a classroom-based course designed to transition interns into professional life. The interns were asked to interview a mock patient diagnosed with either uncomplicated type 2 diabetes or hyperlipidemia. They were to assess the patient’s nutritional requirements, develop a simple care plan, and provide basic nutrition education. In addition, interns were asked to demonstrate their ability to manage the interview by taking time to develop rapport, set one to three simple goals, and to respond to questions. Intern feedback was extremely positive. They commented that they appreciated being able to ‘see’ how they did while engaged in the interview; many indicated that they had a clearer idea of skills to develop.
The simulated interviews are now a dedicated part of the NUTR 466 curriculum. Each intern completes at least two videotaped interviews and additional sessions can be arranged for those who are struggling or who want extra practice. Feedback from interns continues to be positive. Informal feedback from preceptors and interns (once interns are in placements) suggests that simulation use along with the other practical teaching methods used in NUTR 466 have increased intern confidence and readiness to engage in patient interviews.
Cut the tech
No simulation suite – no problem! It is possible to reap the benefits of videotaped simulation in ways that are relatively simple to organize:
- Ask interns to invite a friend, family member or colleague to act as their mock patient.
- Set up a mock interview room by arranging a table and two chairs in front of a clean wall. Place a video camera on a tripod in front of your set.
- Position the intern and the mock patient in the chairs in front of the camera and begin recording.
- After the interview, download the footage and share it by email or save to a disk or data stick.
All interns experience some degree of “Transition Shock” as they enter the health workforce. However, novel teaching strategies like simulation and video feedback may help to lessen this effect and make the experience enjoyable for both interns and preceptors.
Duchscher JB. (2009). Transition shock: the initial stage of role adaptation for newly graduated registered nurses. Journal of Advanced Nursing, 65(5): 1103-1113.
Fowler-Durham C, and Alden KR. (2008). Enhancing patient safety in nursing education through patient simulation. In Patient Safety and Quality: An evidence-based handbook for nurses: Vol. 3. Available at www.ahrq.gov/qual/nurseshdbk/.
Kramer M. (1974), Reality Shock - Why Nurses Leave Nursing. St. Louis: Mosby.
Heidi Bates, MSc, RD
Director, University of Alberta Integrated Dietetic Internship