Continuing Education of Dietitians in the United Kingdom and Northern Ireland

The British Dietetic Association

Continuing Education of Dietitians in the United Kingdom and Northern Ireland

 

When The British Dietetic Association was founded in 1936, one of its founding principles was to: 
“Promote the training and education of persons engaged or to be engaged, in the science and practice of Dietetics and associated subjects“

Our founders clearly appreciated the need for dietitians to update themselves regularly and consistently if their practice was to be effective and respected.

In 1947, the Association launched, with Newman Publishing, a journal, which over the years has gone through many changes to become the current Journal of Human Nutrition and Dietetics, published by Blackwells. As some members had difficulty in accessing training we introduced in February 2002 a questionnaire associated with one of the papers published in the journal. If correctly answered, the questionnaire affords one hour of accredited study, bringing this traditional tool into a new era. The Association also provided educational sessions at General Meetings and at Branch Meetings. In the early 70’s it started to organise Study Conferences which lasted up to 5 days and which gave the opportunity for general updating and networking to a substantial proportion of the membership.

Since the early 1990’s however there has been the realisation by the public that the self-regulation of professionals does not necessarily provide quality and safety in practice. It has been our unfortunate experience in the UK, that self-regulation cannot guarantee standards of professional practice. Therefore, it has been accepted that mechanisms must be put in place, which aim to ensure that practitioners are aware of the best evidence base in order to keep their practice up to date. In addition, we have become aware that knowledge alone is not enough and that practitioners need to have the capacity for self-reflection if they are to maintain competence and safety.

In 2002 the regulation of the Profession of Dietetics in the United Kingdom passed from the Council for Professions Supplementary to Medicine, which has been the body responsible since 1961, to the Health Professions Council.  Although the mechanisms are not yet determined it is anticipated that the Health Professions Council will require proof of Continuing Professional Development for continued registration and that registrants will demonstrate that they meet the Standards of Proficiency. It is anticipated that the CPD requirement will be introduced in 2006.

 

Professional Portfolio

In 1994, the Association launched its Professional Portfolio for Dietitians aimed at encouraging members to record educational experience and assisting them by providing a framework for keeping their record.

As well as the paper-based version of the portfolio, a CD version is available.

In 1995 the Association launched the Diploma in Advanced Dietetic Practice, which was a major advance in the concept of continuing education for Dietitians.

The major features of the Diploma are:

1.    It is gained over a period of 5 years and requires practice throughout the period

2.    It requires the practitioner to undertake 100 hours of education in the 5 year period with not less than 5 hours in any one year

3.   The Practitioner should undertake a course validated by the BDA or a module validated by one of the recognised universities. Alternatively a paper which has been peer reviewed can be submitted to meet this criteria.

4.   A statement reflecting on how the individual’s practice has been changed by the education and how it has developed must be submitted

 

In order to assure the quality of the Diploma, the Association has trained assessors to assess the submissions and to assure the standard of courses and learning accepted for the 100 hours.

Another feature of the Diploma is that it has a shelf life. Once obtained, its validity is for 5 years unless the follow on Diploma in Advanced Practice 2 is successfully completed. This has proved to be a controversial move and we anticipate that many who successfully completed the Diploma will not appreciate it losing its validity.

There are currently 1562 dietitians registered for the Diploma in Advanced Dietetic Practice, of these, 201 have registered for Diploma II.

 As of March 2003 a total of 489 Diploma certificates have been awarded.

The drop-out rate for the award is approximately 8%

In 1998, the Association published its policy on Continuing Professional Development.

In its introduction, the Association states its commitment to assisting members to uphold the highest standards of professional practice and develop themselves continuously throughout their working lives. Principles were laid down and it included this policy statement:

“All members are expected to structure their learning and development and keep a record of their CPD”

It defined Continuing Professional Development as:
“The process by which professionals update, maintain and enhance their knowledge and expertise in order to ensure their continuing competence to practise”.

The main principles of CPD were defined as:

  • The individual is responsible for managing and engaging in CPD activity

  • The learning process is one of continuity involving analysis, action and review

  • Learning objectives should be clear and take account of the needs of both the individual and the organisation

  • The process is planned and based on identified outcomes achieved by the individual

The Association sees CPD as the responsibility of the individual dietitian and applies to all dietitians irrespective of the area in which they work.  It should not be viewed as additional to normal working activities but the means by which dietitians maintain professional competence at work.

It is important to remember that work itself is a learning process worthy of recognition.  CPD seeks to formalise this experiential learning and locate it in a developmental process, which enhances professional practice.  The dietitian should be constantly reviewing what has been learnt and seeking ways to apply this learning in a manner, which will enhance their practice and that of their colleagues and team.

Whilst essentially CPD is the responsibility of the individual dietitian, the BDA recognises that the individual cannot engage in CPD activity in isolation.  Employers and managers should support the dietitian’s professional development by encouraging learning to take place at work and through the provision of learning opportunities.  The BDA also has a responsibility to ensure that a framework exists to give recognition to any CPD activity in which dietitians engage.

The CPD Cycle

The CPD process is continuous.  It involves the individual in
identifying
their development and training needs;
planning
how these needs might be met;
implementing
a plan of action;

They must apply learning on the job
make an assessment
of the benefits of the application of that learning;
identify
further training needs and 
plan
for continued development.

Preparation for CPD

Preparation prior to undertaking CPD activity is essential and should include these key initial steps:

1. Undertake an audit of current competence by referring to existing standards for example the National Professional Standards for Dietitians  Practising in Healthcare and / or local departmental standards:

2. They should set aims and objectives to achieve work related targets and / or personal goals;

3. Identify the knowledge and expertise required to achieve targeted goals;

4. Match expertise against current position in order to identify gaps.  The gaps identified will form the basis of a development plan

 

The development plan should incorporate three elements:

1. Development objectives which should be divided into short term and long term career and development aims;

2. The proposed action to be taken to meet identified development objectives;

3. Planned progress reviews to consider how far objectives have been met

It is important to remember that the individual needs to focus on the learning that has been achieved, and how this learning may be applied to enhance practice.  Reflection on day-to-day practice is an invaluable learning experience.

Evidence of CPD will invariably take a variety of forms, of which the Diploma in Advanced Dietetic Practice may be one.  For example, certificates from courses, research and documented evidence from work based learning such as work shadowing, in service training, project management and secondment.

The published framework has the following requirements:

1.    In order to demonstrate that a state registered dietitian is keeping up to date, the minimum level of CPD activity is at least 5 hours attendance activity per year plus another developmental activity from a designated list, or, pursuing an approved post-registration activity

2.   The BDA will expect records to reflect a balanced mix of activities to include professional work based activities, e.g. involvement in student training, courses / seminars / conferences and self-directed and informal learning

3.    Records must include an analysis of the learning acquired and how it was applied to practice

4.    Through reflection and the process of completing a record, further development needs must be identified.  Each dietitian will have their own development plan identifying further CPD needs

 

There are 3 Provisional Suggested CPD Categories

1. Attendance Activities (Timed)
Lectures
Seminars
Workshops
Professionally related courses
Feedback from courses
Branch meetings Special and interest group meetings
IR training
Employer in-service training
Journal clubs
Work shadowing
Assessed professional distance learning, e.g. Returners to the profession course, Open University

2. Developmental Activities (Untimed)
Case presentations
Poster sessions
Published papers or articles
Peer reviews
Carrying out / presenting research
Project management
Clinical audit
Quality assurance / clinical effectiveness
Visits to centres of excellence
Job rotation
Giving lectures
Planning / running a course
Engaging in student training
External examining
Membership of BDA committees
Professional representation on a committee
Mentoring
Secondment

PR / media involvement

3. Post Registration Training  
Diploma in Advanced Dietetic Practice
BDA validated course i.e. the quality and content of the course has been checked by the BDA
Higher degree relevant to professional dietetic practice

Our aim is that Dietitians should provide records demonstrating at least one activity from Attendance and Developmental categories and one activity from Post Registration Training

As time has now elapsed since these policies were produced the Association recognises the need to revisit and revise the policy and will do so in light of the HPC’s framework, which we expect to be published next year.

When CPD becomes mandatory it is expected that a random survey of individuals CPD activities will be done on an annual basis.  Dietitians can expect that their development records will be checked at least once in a five-year period

As these principles started to become embedded in members thinking, the Association became aware of a demand for a more formal and not time limited, post graduate educational qualification. In order to meet this demand the Association has explored the possibility of creating a MSc programme in Advanced Dietetic Practice. To do this we are in the process of creating partnerships with a number of Universities in order to deliver a flexible programme that can be accessed by Dietitians throughout the United Kingdom.

The National Health Service in the UK is in the process of setting up a University (NHSU), which will deliver education and training to staff in the Health Service. It will deliver its courses in a variety of ways and it is anticipated that it will use the expertise of other providers to deliver specialist teaching. The BDA hopes to become one of its partners.

Dietitians have very diverse needs with respect to CPD. The BDA supports a number of different initiatives. It has developed self-assessment questionnaires for those who may not have access to formal education or development activities. ‘Re-entrant to the profession’ courses are run regularly. For them an open / flexible learning programme has been developed, modules of which can be accessed by practising dietitians wishing to update themselves in a particular area. Specialist groups offer post-registration education and training with independent validation of learning outcomes and quality of delivery and assessment monitored by the Continuing Education Committee (CEC) of the BDA.

The British Dietetic Association now recognises the need to establish a Centre for Education & Development within the Association and ‘principles’ for its establishment have emerged:

These are

  • Equitable access (relating to location and to dietitians working in different types of post and at different levels of seniority)

  • Credibility, both internal and external to the profession

  • Flexibility in approach, fitting in with the reality of dietitians’ working lives

  • Value for money

  • Quality assured

  • Profession led - Relevant to needs across the profession
    Focused on dietetics but not exclusive to dietitians 
    (promoting multidisciplinary working and shared learning)

  • Not duplicating the role of the BDA or universities

The vision is of functions and services that can be collated into three main clusters:

  • Structured CPD and career development

  • Quality assurance of courses and for the profession: kite-marking external courses, curriculum planning, information about approved courses, clinical governance and development of clinical protocols 

  • Resource centre: information on effectiveness and evidence based practice, sharing best practice, support for research 

The central co-ordinating unit would administer the CPD system and co-ordinate a network of locally based CPD and career development advisors. It is suggested that these advisors would work to a standard framework and would receive training and materials from the centre but would operate on essentially a voluntary basis.  Clearly however, such activity would count towards the advisor’s own CPD and career development.

 

Course Validation

Providers are seen as being universities and other higher education institutions, charitable or voluntary agencies, other professional associations or groups or commercial enterprises as well as the BDA.  Some providers will deliver courses and activities specifically focused on dietetics but others might run activities on more generic topics relevant to a range of professional groups.  Included in this would be a cluster of universities, which would provide the MSc in Advanced Dietetic Practice and of course the NHSU. Although the awards may be conferred by a small number of universities, it is envisioned that a partnership of institutions would operate a transferable credits system allowing dietitians to take different modules from different institutions to build up an individualised degree. The modules and awards will be accredited by the institutions themselves and will be run on a self-financing basis with fees payable directly to the institutions. 

The Centre will be responsible for quality assurance of courses and other activities as well as a role in supporting evidence based practice and developing clinical governance.

A resource centre will also provide support for research, perhaps maintaining a directory of research activity in dietetics.  It has also been suggested that electronic networks could be managed for those who can offer advice on best practice in specialist areas. 

All this will pose significant re-organisation issues for the BDA as well as financial risks.  However there is a high level of support for the establishment of a Centre amongst the membership.

 

Conclusion

The British Dietetic Association has over a long period supported its members to remain competent to practise.  The advent of the Health Professions Council and its stated objective of introducing mandatory CPD as a pre-requisite for staying on the register has been the impetus for developing new ways of helping members to maintain their fitness to practice. It has done this by a variety of methods and invested resources commensurate with its aspirations, size and income. Changing views on the role and responsibilities of professionals as well as consumer led opinion mean that self-regulation is insufficient to maintain public confidence in the system. The Association’s response has been to develop a range of activities for members, which will enable them to remain competent to practise.

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