Tuesday, June 8, 2010

Using Simulation and Video Feedback to Enhance Dietetic Interns’ Counselling Skills and Confidence

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.

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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
Edmonton AB
E: hbates@ualberta.ca


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Were there any common threads among what people took away from this exercise?

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We overcame the nervousness of counseling and felt more confident in our knowledge translation to clients.
This exercise forced us to start applying the theoretical knowledge into understandable, "people-friendly" terms.
I found the simulation helpful because often times we don't know what we sound like, or how we act when doing mock counseling sessions with classmates. We just become muddled in our thoughts of getting as much information across without truly seeing/knowing what we are doing. The simulation opened our eyes to help us become better interns.

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पंछी कभी अपने बच्चों के भविष्य के लिए घोंसले बनाकर नहीं देते,
वे तो बस उन्हें ‘उड़ने’ की कला सिखाते हैं

suvichar everything is possible

Aaj Ka Suvichar
इंसान अगर ठान ले तो असंभव कुछ भी नहीं
असंभव शब्द का इस्तेमाल कायर करते हैं

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बुरे लोगो को भगवान बहुत कुछ देता है मगर साथ नहीं देता.
हो सके तो जीवन में दो काम कभी भी मत करना,
कमजोर केवल इच्छा करते है

किसी से बस उतना ही दूर होना
अच्छे लोगो को भगवान परेशान करता है मगर साथ कभी नहीं छोड़ता,
एक जूठे इंसान से प्रेम और सच्चे इंसान से गेम.
Hindi Suvichar With Images
असंभव से भी आगे निकल जाना.
जबकि महान लोगो में इच्छा शक्ति होती है Inspirational Suvichar In Hindiरफ़्तार ज़िन्दगी की कुछ युँ बनाए रखिये केकोई दुश्मन आगे ना निकल जाए और कोई दोस्त पीछे ना छूट जाये. Hindi Suvichar On Lifeक्रोध एक ऐसा तेजाब है जो जिस चीज़ पे डाला जाता है उससे,ज्यादा उस पात्र को नुकसान पहुंचाता है जिसमे वो रखा है. Pictures Of Hindi Suvicharहम ख़ुशी के विषय में सोचेंगे तो हम खुश रहेंगे,हम दुःख के विषय में सोचेंगे तो हम दुखी रहेंगे. Suvichar Khush Rahna Sikho
अपनी चाहत की चीजो को पाने की कोशिश के साथ

की उसे आपकी अहमियत का अहसास हो जाए इतना दूर भी नही की वो आप के बिना जीना सिख ले Suvichar In Hindi Wallpapersसंभव और असंभव के बिच की दूरी,व्यक्ति के निश्चय पर निर्भर करती है. Hindi Suvichar Photoस्वयं को कभी कमज़ोर साबित ना होने देक्यूंकि डूबते देखकर लोग घर के दरवाजे बंध करने लगते है. Pictures For Suvichar In Hindiरातों को नींद आना आसान बात नहीं है,उसके लिए पूरा दिन ईमानदार रहना पड़ता है. Suvichar Gyan
उससे थोडा दूर ही रहना चाहिए Hindi Suvichar Pictures मदद करने के लिए सिर्फ ही धन की जरुरत नहीं होती है,उसके लिए एक अच्छे मन की जरुरत होती है. Hindi Suvichar Wallpapersऔरतो को देने वाले उपहार में सबसे बेहतरीन उपहार है उसकाआदर करना, जो हर को ही नसीब नहीं होता. Motivational Suvicharदूसरों को इतनी जल्दी माफ़ कर दिया करो,जितनी जल्दी आप उपरवाले से अपने लिए माफ़ी की उम्मीद रखते हो. Suvichar Sambhal Ke Rehna
संभव की सीमा जानने का एक ही तरीका है,
हमेशा किसी के नज़दीक रहना है तो
Suvichar Hindi Wallpapers
सभल के रहना उन इन्सान से
Suvichar In Hindiजिसे समय का सदुपयोग करने की कला आ गई,उसने सफलता के रहस्य को समज लिया है. Hindi Suvichar Wallpapersलगातार हो रही असफलताओं से निराश नहीं होना चाहिए,कभी कभी गुच्छे की आखरी चाबी ताला खोल देती है. Hindi Suvicharआप जीवन में कितने भी ऊँचे उठ जाए पर,अपनी गरीबी और कठिनाई के दिन कभी मत भूलिए. Mhan Log Suvichar
Hindi Suvicharभगवान कहते हैं उदास मत होना कूयोकि में तुम्हारे साथ हू सामने नहीं परआसपास हू पलकों को बंद कर दिल से याद करना में और कोई नहीं तेरा आत्मविश्वास हू. . Suvichar Hindi Me
कभी कभी किसी का ध्यान आकर्षित करने का सबसे बेहतर तरीका उस वक्ती पर ध्यान ना देना ही होता है

जिसके दिल में भी दिमाग होते है Suvichar Hindi For Facebookदूसरा मौका सिर्फ कहानिया देती है, जिंदगी नहीं तुम बस जैसे हो वैसे हो जाओ,बस अपने को कुछ और बताना छोड़ दो. Hindi Suvichar For Pupils इंसान के जिस्म का सबसे खूबसूरत हिस्सा है"दिल",वो ही साफ न हो तो चमकता"चेहरा" किस काम का. Emotional Suvichar In Hindiसबंधो को निभाने के लिए समय निकालिये वरनाजब आपके पास समय होगा तब तक सबंध ही न बचे. Suvicha Jena Sekh Le

Hindi Suvichar
जो चीजें आपके पास है उन्ही से खुश रहना सीखो
Abdul Kalam Quotes सुविचार in Hindi

Positive Suvichar
इंसान को कठिनाइयों की आवश्यकता होती है,
क्यूंकि सफलता का आनंद उठाने के लिए ये जरूरी हैं
– अब्दुल कलाम का सुविचार


Beautiful Suvichar

अगर जीवन में कुछ पाना है,
तो अपने तरीके बदलो इरादे नहीं

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गलत लोगों की जीत उसी वक्त तय हो जाती है
जब सही लोग चुप हो जाते हैं

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