Aspiring dietitians study: a pre-enrolment study of students motivations, awareness and expectations relating to careers in nutrition and dietetics.

Abstract

Objective: To qualitatively explore the attitudes, expectations and career plans of aspiring dietetic students.

Design: Qualitative study involving open-ended semi-structured face-to-face interviews.

Subjects: Sixty-three student applicants to the Griffith University Master of Nutrition and Dietetics Program over the 2002-2003 period.

Main outcome measures: Attitudinal data about the motivations, competency expectations and career plans of Nutrition and Dietetic program applicants.

Analysis: Qualitative content analysis.

Results: Student applicants had a mix of health science and exercise science undergraduate training backgrounds, were in their early to mid-20s and were recent graduates. The most common motivations for becoming a dietitian was a long-term primary interest in nutrition, health and helping people inspired by previous experience with other dietitians, family or personal illnesses and significant others such as mothers and teachers. Approximately 30% of applicants reported being motivated by personal experiences (self or friends) with obesity or eating disorders. High-level communication and organisational skills and nutrition knowledge were the common competency expectations of dietitians among potential students. Most reported working clinically, running a private practice (particularly in sports nutrition) or in mixed practice settings with autonomy and practice diversity as long-term career aspirations. There was a generally low level of specific awareness of public health nutrition or food service management practice opportunities in the profession.

Conclusions: There appears to be a need to further market the diversity of practice in the profession to senior school-age and undergraduate students so that applicants are more informed of the realities of career opportunities.

Key words: career plans, competencies, student dietitians

(Nutr Diet 2005;62:106-109)

Introduction

Workforce development in the nutrition and dietetic profession can focus on three temporally discrete phases, including pre-enrolment, training and post-employment phases. Most of the focus in the literature to date has been on workforce development activity after students have been admitted to dietetic training programs (training phase) (1,2) or the post-entry level (post-employment stage). (3,4) There has been limited consideration about the effect that pre-enrolment phase factors, such as public awareness of the nature of nutrition and dietetics careers and perceptions of career prospects, have on the development of the nutrition and dietetic workforce. With over 300 students accepted into and graduating from dietetic training programs around Australia each year (5) (representing growth and/or turnover of approximately 10% of the national dietetic workforce), the impact of university recruitment practices on the profile of the profession is likely to be significant.

There have been a number of reviews (6,7) and research investigations (8-11) of the reliability, validity and predictive value of various student application processes in health professions such as medicine, dentistry and physiotherapy. This literature (6-11) suggests considerable controversy about the utility of interviews as a student assessment procedure. Some of the rationale for use of interviews in the literature include being able to probe experience and knowledge of the profession, source of motivation, interpersonal behaviour, commitment and background. (7) Studies that draw favourable conclusions suggest that interviews provide information that has predictive power of student success and postgraduate work performance, beyond that collected by other methods. (6) The major criticism cited about interviews apart from variable reliability is the cost and logistical difficulties associated with their administration. (7) A consistent theme from this research (6-11) is the need for ongoing research and development of methods to assess noncognitive characteristics of applicants (such as motivation, personality and empathy), in order to assist student selection. (7,8)

University application procedures for entry to dietetics programs in Australia vary depending on the level of the degree program (undergraduate vs postgraduate) and institutional differences. A quick search of university web sites demonstrate that most undergraduate programs recruit students based on tertiary entrance type scores, which reflect summative academic ratings based on secondary education performance. Masters level programs have variable selection methods but include a combination of personal interviews, referees reports, curriculum vitae review and ranking of undergraduate academic performance.

One of the potential advantages of considering students for dietetic program places based on information obtained from traditional employment selection processes such as an interview, is to access interpersonal and communication skills. (6,7) These skills are considered by much of the recent competencies scholarship as being core competencies for nutrition and dietetic practitioners, regardless of practice context. (12,13) Interviews also enable consideration of student motivations for pursuing careers in nutrition and dietetics and career expectations. The advantage of this information is to ensure that student's expectations reflect the reality of practice in order to avoid student wastage (i.e. student drop-outs due to dissatisfaction or expectations not being met). Research on the effect of interviews on student attrition in other professions, however, has found no effect. (11) There have been no published studies that have investigated students' motivations for considering dietetics as a career option in Australia. One USA-based study in the late 1990s surveyed students about the influences on career decisions towards the end of their studies. (14)

The present study aimed to qualitatively explore the attitudes, expectations and career plans of aspiring dietetic students in the pre-enrolment phase of workforce development. It also served to enable reflection on the utility of student interviews as part of the student selection process for postgraduate entry-level dietetic training and provide baseline data for future prospective follow up on the predictive value of interview ratings on student performance.

Method

A qualitative study design using semi-structured interviews was used. Ethics approval was obtained from the Griffith University Human Research Ethics Committee.

Subject recruitment

The student selection process involved a two-stage process including initial review of application documents (including undergraduate course transcripts, written statements, curriculum vitae and referees reports) followed by an interview for students ranked worthy in the written application assessment phase. Sampling for the present study included all student applicants to the Master of Nutrition and Dietetics program at Griffith University over the 2002-2003 period who progressed to interview stage. Program applicants were invited to give informed consent for their responses at interview to be noted and included in analysis and reporting stages of the present study.

Data collection

A series of semi-structured interviews were conducted using a list of open-ended questions (Table 1) used as a basis for discussion. Each interview lasted about 30 minutes. Responses were recorded in real time independently by both researchers in abbreviated form rather than verbatim, so a degree of researcher interpretation and categorisation of responses occurred independently in the data collection stage of the present study.

Analysis

Recorded responses from interviews from both researchers were sorted independently by each of the researchers using a content analysis approach. The researchers then compared and discussed the response themes identified in the independent sorting and categorisation stage to check for differences in interpretation of responses and key theme identification to enhance analytical validity. (15) Pseudo-quantitative analysis (counts) of response themes was used to identify most regular response themes.

Results

Demographics and employment characteristics

Student applicants predominantly had a mix of health science and exercise science undergraduate training backgrounds. There were a small proportion (11/67) of mature-age student applicants who had work experience in other health or education fields and were changing career paths. Most student applicants were female (58/67) in their early to mid-20s and were immediate graduates from undergraduate bachelor programs with academic performance records of credit or higher grade averages.

Motivations for pursuing a career in dietetics

The most common response theme reported relating to motivations for becoming a dietitian was a long-term primary interest in nutrition and health. A 'passion for nutrition' was a commonly used phrase among interviewees. A desire to work in a profession helping others and working with people were other common themes. Undergraduate experiences of nutrition as a content area was also a source of motivation for pursuing dietetics as a career. Dietetics as a career was viewed as an opportunity to combine an interest in nutrition with helping people improve their health.

Competency needs

Aspiring students identified more than 20 different competencies elements (knowledge, skills and attributes) considered to be needed by dietitians. High-level communication, interpersonal and organisational skills were common response themes. Specialist nutrition knowledge and education and counselling skills were also a common competency expectations of dietitians among potential students. Empathy was also an attribute considered important among dietitians by more than one-third of interviewees. The ability to work in teams and be self-directed were also common expectations.

Factors influencing selection of dietetics as a career option

The main factors influencing this motivation were previous experience with other dietitians, family and personal illnesses. Approximately 30% of applicants had been motivated by personal experiences (self, family or friends) with obesity, eating disorders, or both. Exposure to dietitians as a patient in the past or academics with a nutrition focus were other influencers, as were mothers and school teachers.

Career expectations

When asked to describe what they would like to be doing career-wise in 10 years time, most interviewees reported working in a clinical/hospital position, running a private practice (particularly in sports nutrition), or working in mixed practice settings with autonomy and diversity. A few applicants reported that they hoped to have started a family within 10 years, but most responses focused on career expectations. Many interviewees indicated that they expected to spend a number of years getting experience in the hospital setting before branching out into private practice. Participating in research, at least part-time, was also another common career prediction. There was a generally low level of awareness of public health nutrition as a career path option, although a number of interviewees reported an interest in branching into disease prevention without specific awareness of the nature of public health nutrition as a career path for dietitians. Food service management practice ambitions were noticeable by their absence among interviewee responses.

Plan B

When asked to comment on their plans if they were not offered a place in the nutrition and dietetics program, most reported they would try again after further study or having work experience. Applying for undergraduate dietetic program places or masters programs at other universities were also common response themes. Responses seemed to indicate that the large majority of interviewees were particularly focused on dietetics as their career choice with few volunteering that they would consider other career options in the event of not securing a place in a dietetic program.

Discussion

The demographic and educational profile of student applicants included in the present study reflect the program prerequisite study stipulations of the Master of Nutrition and Dietetic Program at Griffith University, being a health science or equivalent undergraduate degree with at least second-year level studies in human biochemistry and physiology. It is likely that the responses obtained from students with this background, life experience and age will be different to that obtained if asked of students applying for undergraduate programs.

Data from aspiring dietitians interviewed in the present study suggest that the main motivations for pursuing a career in dietetics were similar to findings from an earlier study that identified interest in nutrition and working with people as important motivations for their career decision. (14) The perception of dietitians as nutrition content specialists working with people to help maintain and promote health on a person-to-person basis is consistent with recent research exploring the public's perceptions and knowledge regarding dietitians. (16) Competency expectations of potential students reinforce the perception of dietitians as communicators and carers and with skills and attributes that denote professionalism (e.g. self-directed, organised, team players).

Potential students appear to have narrow views about the opportunities and diversity of practice that present in nutrition and dietetic careers. The most common career expectation of hospital-based or private practice direct-patient care correspond with the distribution of dietitians in the health workforce (17) and the information presented on the Dietitians Association of Australia web site about where members are employed (http://www.daa.asn.au/public/careers/index.asp). Limited awareness of career paths leading to food service management, public health nutrition or food industry careers and opportunities for dietitians appears to underpin this narrow career outlook. Many students expect to spend considerable time in the early stages of their postgraduation careers in hospital-based clinical practice. This reflects actual career paths reported by dietitians working in less common practice areas such as public health nutrition. (4) This perception may contribute to workforce and career development inefficiencies in practice areas such as public health nutrition because of the opportunity costs associated with developing clinical skills rather than public health skills. (4) The popularity of careers in sports nutrition is inconsistent with the reality of employment opportunities and labour demand in this field, and if left unchecked may be a potential source of career dissatisfaction. Students may require career counselling, prior to and during training about the limited career prospects in this field relative to the actual labour market. Although difficult to confirm from the data collated in the present study, the reported preference for private practice work in the future may reflect a largely unexpressed plan to be mixing family with work commitments.

The significant proportion of students who reported that they had been influenced by personal experience of obesity or eating disorders (and in some cases experience as a patient of dietitians) to pursue dietetics careers raises a number of ethical and professional issues. What are there risks to the individual student and/or the public associated with training students with prior (and possibly unresolved) eating disorders? Does experience of this disorder compromise competencies or does it enhance the empathy and insight about caring for these patient types? Equally important are deliberations about the potentially discriminatory nature of considerations about prior illness as a basis for student selection. The public perception of dietitians appears to be that of a fit, healthy and professional woman. (16) What is the effect of recruiting as students, individuals who do not fit this stereotype because of prior or current disorders or illness? These are questions that require more debate and research by the dietetics profession, particularly among academics involved in student selection for dietetic training programs. The common experience of obesity reported may simply reflect the high prevalence of overweight and obesity in the Australian community.

Given the role of the interview as a contributing process in the student selection procedure, it is possible that responses to questions in the present interview process represent what interviewees perceive to be the most desirable responses (i.e. those that will enhance their chances of obtaining a place in the program). This is a form of social desirability bias. If this bias exists, responses reflect the perceptions that aspiring students have about what responses interviewers (in this context dietetic academics) will rate highly. Either way, these perceptions provide insights into the perceptions of students about their dietetics careers, competency needs and the broader profession. These insights provide pointers for marketing targeting dietetic student recruitment and education prior to dietetic training. Workforce development efforts can be proactive and 'upstream' by focusing on the pre-enrolment phase, ensuring that expectations of aspiring student dietitians match realities, and practitioner motivations and attributes correspond with those recognised as important for effective workforce performance.

Subjective insights about the value of interviews in student selection

Our experience of using interviews as part of the student selection process suggests that although time-intensive for academics, this process does provide an opportunity to assess communication skills, scrutinise student motivation, awareness and expectations of the profession and their careers. We plan to further test this subjective opinion by tracking this student cohort to assess if interview ratings are predictive of performance in the dietetic program and later employment. This knowledge can assist with specific counselling of students who have unrealistic expectations, prevent student attrition and identify students who may not be suited to dietetic practice. In this context, this investment in academic time may be well spent.

Acknowledgements

The participation of the 67 student applicants interviewed in the present study is appreciated. The constructive feedback by the anonymous reviewers is also appreciated.

References

1. Winter J, Matters H, Nowson C. A problem-based approach to clinical education in dietetics. Nutr Diet 2002; 59: 23-8.

2. Torres S, Winter J, Matters H, Nowson C. Direct patient contacts of dietetic students during their final clinical placement. Nutr Diet 2002; 59: 18-22.

3. Hughes R. Competency development needs of the Australian public health nutrition workforce. Public Health Nutr 2003; 6: 839-47.

4. Hughes R. Competency development in public health nutrition: reflections of advanced level practitioners in Australia. Nutr Diet 2003; 60: 198-204.

5. Hughes R. An Audit of Dietetic Education Programs, Faculty, Student Numbers and Issues Affecting Workforce Preparation in Australia. Proceedings of the 21st National Dietitians Association of Australia Annual Conference. Deakin: Dietitians Association of Australia, 2003.

6. Ferguson E, James D, Madeley L. Factors associated with success in medical school: systematic review of the literature. Br Med J 2002; 324: 952-7.

7. Salvatori P. Reliability and validity of admissions tools used to select students for the health professions. Adv Health Sci Educ 2001; 6: 159-75.

8. Kreiter C, Yin P, Solow C, Brennan R. Investigating the reliability of medical school admissions interview. Adv Health Sci Educ 2004; 9: 147-59.

9. Gafni N, Moshinsky M, Kapitulnik J. A standardised open-ended questionnaire as a substitute for a personal interview in dental admissions. J Dent Educ 2003; 67: 348-53.

10. Basco W, Gilbert G, Chessman A, Blue A. The ability of medical school admission process to predict clinical performance and patients satisfaction. Acad Med 2000; 75: 743-7.

11. Gabard D, Porzio R, Oxford T, Braun R. Admission interviews: questions of utility and cost in masters of physical therapy programs in the United States. Physiother Res Int 1997; 2: 135-49.

12. Hughes R. Competencies for effective public health nutrition practice: a developing consensus. Public Health Nutr 2004; 6: 839-47.

13. Phillips S, Ash S, Tapsell T. Dietitians' views on the current competency standards for entry level dietitians. Aust J Nutr Diet 2000; 57: 190-97.

14. Kobel K. Influences on the selection of dietetics as a career. J Am Diet Assoc 1997; 97: 254-7.

15. Bowling A, ed. Research Methods in Health. Investigating Health and Health Services. Buckingham: Open University Press, 1997.

16. Wolf K. The Public's Perceptions and Knowledge Regarding Dietitians. Proceeding of the 14th International Dietetics Congress. Chicago: American Dietetics Association, 2004.

17. AIHW. Profile of Dietitian Labour Force Australia 1996. Canberra: Australian Institute of Health and Welfare, 2000.

School of Public Health, Griffith University, Gold Coast, Queensland 

R. Hughes, BSc, GradDipNutrDiet, PGradDipHlthPromo, MPH, APD, PhD, RPHN, Deputy Head

B. Desbrow, BSc, GradDipNutDiet, MAppSc, M Nutr Diet Program Convenor

Correspondence: R. Hughes, School of Public Health, Griffith University, PMB 50, Gold Coast Qld 4217, Australia. Email: [e-mail]

R. Hughes and B. Desbrow collaborated to conceptualise the study, conduct the student interviews, transcribe and independently analyse the data. R. Hughes drafted this manuscript with editorial input and revision from B. Desbrow.

Table 1. Interview questions guide and inquiry logic

Question                            Inquiry logic

Why do you want to be a dietitian?  Explores students' motivations.
What skills and attributes do you   Explores students' expectations of
  think are needed to be an           competency needs and work
  effective dietitian?                performed.
What factors influenced your        Identifies source of motivation and
  selection of dietetics as a         awareness relevant to career
  career option?                      choice.
What would you like to be doing     Explores students' career
  career-wise in 10 years time?       expectations. Do they have a long-
                                      term vision of where dietetics
                                      will take them career-wise?
What is plan B (you don't get a     How focused are students on
  place in this program)?             dietetics as a career.
                                    Have they developed a contingency
                                      plan?