School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
Monash Centre for Scholarship in Health Education, Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia.
Nutr Diet. 2019 Feb;76(1):38-46. doi: 10.1111/1747-0080.12430. Epub 2018 May 6.
Competency-based Education (CBE) has underpinned the education of dietitians in Australia since the first Competency Standards (CS) were published; however, little is known about how CBE has influenced dietetic practice. The aim of this paper is to explore how a CBE framework and the CS have influenced dietetic practice in Australia since 1990.
A qualitative investigation explored concepts of dietetic practice. Data analysed were original interviews previously undertaken with recent graduate dietitians during 1991 (n = 26), 1998 (n = 23) and 2007 (n = 19) and seven guided discussions with dietitians and employers (n = 28) conducted in 2014 to identify themes. The DAA Competency Standards and Accreditation Manuals/Standards since 1990 were also analysed to triangulate the interview data and to investigate how the CS were interpreted.
Themes identified from interviews included: (i) communicating for better care, (ii) scientific enquiry for effective practice, (iii) critical thinking and evidence-based practice and (iv) professionalism, which remained core to dietetic practice over time, but leadership, advocacy, business management and entrepreneurial skills have emerged more strongly as the scope of practice has diversified. The landscape in which dietitians' practice showed increasing complexity and clear boundaries separating professional roles were disappearing. The 2015 CS and the 2017 Accreditation Standards highlighted that competency remains a shifting construct and that professional behaviours change depending on economic and political reasons in the play of power. Accreditation policy and current standards have successfully maintained a standard of dietetic practice across a diverse country but have the potential to constrain innovation.
自澳大利亚首次发布能力标准（CS）以来，基于能力的教育（CBE）一直是营养师教育的基础；然而，人们对 CBE 如何影响饮食实践知之甚少。本文的目的是探讨自 1990 年以来，CBE 框架和 CS 如何影响澳大利亚的饮食实践。
一项定性研究探讨了饮食实践的概念。分析的数据是 1991 年（n=26）、1998 年（n=23）和 2007 年（n=19）期间对最近毕业的营养师进行的原始访谈（n=26）以及 2014 年与营养师和雇主进行的七次指导讨论（n=28）中获得的主题。还分析了自 1990 年以来的 DAA 能力标准和认证手册/标准，以对访谈数据进行三角剖分，并研究 CS 是如何解释的。
访谈中确定的主题包括：（i）沟通以实现更好的护理，（ii）科学探究以实现有效的实践，（iii）批判性思维和循证实践，以及（iv）专业精神，这些主题随着时间的推移仍然是饮食实践的核心，但领导力、倡导、企业管理和创业技能作为实践范围的多样化，已经越来越重要。营养师实践所处的环境显示出越来越复杂的趋势，并且专业角色之间的清晰界限正在消失。2015 年的 CS 和 2017 年的认证标准强调，能力仍然是一个不断变化的结构，并且由于权力博弈中的经济和政治原因，专业行为会发生变化。认证政策和现行标准成功地维持了整个多元化国家的饮食实践标准，但有可能限制创新。
