Dietetics Students' Perceived Facilitators and Barriers to Clinical Training in Malaysia: A Qualitative Theory-Guided Analysis

Nur Amirah Nabihah Eshamuddin, Lim Jun Hao, Chin Yi Ying

Abstract

This study explored barriers and facilitators experienced by Malaysian dietetics graduates during clinical training in local healthcare settings. A qualitative study with phenomenological design was conducted on fifteen purposely selected fresh dietetics graduates, with a mean age of 24.7±0.8 years from seven local universities. Virtual interviews were conducted via the Cisco Webex and were verbatim transcribed and thematically analyzed using NVivo 12 Plus software. Data collection continued until data saturation was reached. Nine Theoretical Domain Frameworks (TDF-derived domains), comprising of 1) knowledge, 2) skills; 3) belief about capabilities; 4) intention; 5) goals; 6) memory, attention, and decision process; 7) environmental context and resources; 8) social influences; and 9) emotions domains, was utilized to develop open-ended questions in the semi-structured questionnaire. Within these domains, frequently associated sub-themes of perceived facilitators were identified: early preparation and comprehension. Pre-clinical classes that involve solving diverse and challenging cases equip students with practical understanding of clinical training. Curriculum-based university clinics offer valuable insights into hospital dietetics practice. Resources availability is crucial for effective Nutrition Care Process (NCP) implementation and aids in evidence-based nutrition counseling. Conversely, the factor that hinders clinical training reported by dietetics graduates is a lack of knowledge and readiness, particularly concerning their perceived knowledge before clinical training. Dissatisfaction also arises from challenges in building rapport, gathering patient information during counseling, and difficulties in assessing dietary recall with patients from diverse cultural backgrounds, affecting their readiness for dietetics practice and therefore, highlighting the need to enhance multicultural knowledge and cultural competency training among dietetics students. The findings from this study may assist in developing strategies to promote impactful experiences and enhance dietetic students' preparedness for clinical practice.

References

Coakley KE, Gonzales-Pacheco D. 2022. Dietetics Students' perceptions of academic and health impacts of the COVID-19 pandemic. Top Clin Nutr 37(3):227. https://doi.org/10.1097/tin.0000000000000291
DeJonckheere M, Vaughn LM. 2019. Semistructured interviewing in primary care research: a balance of relationship and rigour. Fam Med Community Health 7(2). https://doi.org/10.1136/fmch-2018-000057
Guest G, Namey E, Chen M. 2020. A simple method to assess and report thematic saturation in qualitative research. Plos One 15(5):p.e0232076. https://doi.org/10.1371/journal.pone.0232076
Gibson S, Dart J, Bone C, Palermo C. 2015. Dietetic student preparedness and performance on clinical placements: Perspectives of clinical educators. J Allied Health 44(2):101‒107.
Haith-Cooper M, Waskett C, Montague J, Horne M. 2018. Exercise and physical activity in asylum seekers in Northern England; using the theoretical domains framework to identify barriers and facilitators. BMC Public Health 18(1):1‒11. https://doi.org/10.1186/s12889-018-5692-2
Hack R, Hekmat S, Ahmadi L. 2015. Examining the cultural competence of third-and fourth-year nutrition students: A pilot study. Can J Diet Pract Res 76(4):178‒184. https://doi.org/10.3148/cjdpr-2015-018
Hand RK, Davis AM, Thompson KL, Knol LL, Thomas A, V Proaño G. 2021. Updates to the definition of evidence-based (dietetics) practice: Providing clarity for practice. J Acad Nutr Diet 121(8):1565. https://doi.org/10.1016/j.jand.2020.05.014
Hewko S, Oyesegun A, Clow S, VanLeeuwen C. 2021. High turnover in clinical dietetics: A qualitative analysis. BMC Health Serv Res 21:1‒10. https://doi.org/10.1186/s12913-020-06008-5
Jager M, den Boeft A, Leij‐Halfwerk S, van Der Sande R, van den Muijsenbergh M. 2020. Cultural competency in dietetic diabetes care—A qualitative study of the dietician’s perspective. Health Expect 23(3):540‒548. https://doi.org/10.1111/hex.13019
Karupaiah T, Reinhard T, Krishnasamy S, Tan SP, Se CH. 2016. Incorporating the nutrition care process model into dietetics internship evaluation: A Malaysian University experience. Nutr Diet 73(3):283‒295. https://doi.org/10.1111/1747-0080.12265
Kellett J, Bacon R, Lawlis T, Isbel S, Frost J. 2018. Embracing simulation techniques in dietetics education to create novel and effective learning experiences. Nutr Diet 75(S1): 68-121. https://doi.org/10.1111/1747-0080.12427
Knight A, Baldwin C, Reidlinger DP, Whelan K. 2020. Communication skills teaching for student dietitians using experiential learning and simulated patients. J Hum Nutr Diet 33(5):601‒613. https://doi.org/10.1111/jhn.12743
Landry MJ, Bailey DA, Lee M, Van Gundy S, Ervin A. 2022. The impostor phenomenon in the nutrition and dietetics profession: An online cross-sectional survey. Int J Environ Res Public Health 19(9):5558. https://doi.org/10.3390/ijerph19095558
Lövestam E, Vivanti A, Steiber A, Boström AM, Devine A, Haughey O, Kiss CM, Lang NR, Lieffers J, Lloyd L et al. 2020. Barriers and enablers in the implementation of a standardised process for nutrition care: Findings from a multinational survey of dietetic professionals in 10 countries. J Hum Nutr Diet 33(2):252‒262. https://doi.org/10.1111/jhn.12700
Markwell KE, Ross LJ, Mitchell LJ, Williams LT. 2021. A self‐determination theory analysis of reflective debrief themes about dietetic student placement experiences in hospital: implications for education. J Hum Nutr Diet 34(1):115‒123. https://doi.org/10.1111/jhn.12808
Mata ÁNDS, de Azevedo KPM, Braga LP, de Medeiros GCBS, de Oliveira Segundo VH, Bezerra INM, Pimenta IDSF, Nicolás IM, Piuvezam G. 2021. Training in communication skills for self-efficacy of health professionals: A systematic review. Hum Resour Health 19(1):1‒9. https://doi.org/10.1186/s12960-021-00574-3
McCabe CF, O’Brien-Combs A, Anderson OS. 2020. Cultural competency training and evaluation methods across dietetics education: A narrative review. J Acad Nutr Diet 120(7):1198‒1209. https://doi.org/10.1016/j.jand.2020.01.014
McGowan LJ, Powell R, French DP. 2020. How can use of the theoretical domains framework be optimized in qualitative research? A rapid systematic review. Br J Health Psychol 25(3):677‒694. https://doi.org/10.1111/bjhp.12437
Teng NIMF, Najlan AFA. 2019. Determining dietetics students' readiness to practice: an exploration of student perceptions. Pak J Nutr 18(2):178–185. https://doi.org/10.3923/pjn.2019.178.185
Morgan K, Campbell KL, Sargeant S, Reidlinger DP. 2020. Preparedness for advancing future health: A national qualitative exploration of dietetics graduates' experiences. Adv Health Sci Educ 25(1):31–53. https://doi.org/10.1007/s10459-019-09904-6
Olsson LE, Jakobsson Ung E, Swedberg K, Ekman I. 2013. Efficacy of person‐centred care as an intervention in controlled trials–a systematic review. J Clin Nurs 22(3‒4):456‒465. https://doi.org/10.1111/jocn.12039
Porter JM, Devine A, Vivanti A, Ferguson M, O'Sullivan TA. 2015. Development of a nutrition care process implementation package for hospital dietetic departments. Nutr Diet 72(3):205‒212. https://doi.org/10.1111/1747-0080.12169
Ross LJ, Mitchell LJ, Williams LT. 2017. Is it possible to enhance the confidence of student dietitians prior to professional placements? A design‐based research model. J Hum Nutr Diet 30(5):588‒595. https://doi.org/10.1111/jhn.12479
Showkat N, Parveen H. 2017. In-depth Interview. https://www.researchgate.net/publication/319162160_In-depth_Interview
Swanepoel E, Tweedie J, Maher J. 2016. Building dietetic student confidence and professional identity through participation in a university health clinic. Nutr Diet 73(3):229‒234. https://doi.org/10.1111/1747-0080.12268

Authors

Nur Amirah Nabihah Eshamuddin
Lim Jun Hao
Chin Yi Ying
chinyiying@unisza.edu.my (Primary Contact)
EshamuddinN. A. N., HaoL. J., & YingC. Y. (2024). Dietetics Students’ Perceived Facilitators and Barriers to Clinical Training in Malaysia: A Qualitative Theory-Guided Analysis. Jurnal Gizi Dan Pangan, 19(Supp.1), 9-18. https://doi.org/10.25182/jgp.2024.19.Supp.1.9-18

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