Nutrition care planning: comparison of the skills of dietitians, interns, and students

A written case study--or patient management problem--was used to examine how the nutrition care planning process is influenced by increasing clinical experience. The sample consisted of 45 students in diet therapy courses, 46 dietetic interns, and 44 experienced clinical or generalist dietitians. The patient management problem tested data gathering, with sections containing information needed to assess nutritional status, and nutrition care planning, in which subjects identified and evaluated problems and selected short- and long-term goals. Performance was scored by comparing subjects' answers with those of five dietetic experts. Dietitians scored highest and students scored lowest on efficiency of data gathering. Dietitians and interns scored higher than students on proficiency of data gathering and nutrition care planning. Overall, dietitians and interns performed better than students. Only in tasks requiring the highest levels of information processing and/or confidence in clinical judgment were differences between dietitians and interns consistently found. These findings demonstrate that basic nutrition care planning skills are acquired during dietetic internships, but advanced skills are added with clinical experience.