Simulation-Based Training for Nutrition-Focused Physical Exams and Malnutrition Diagnosis for Rural Preceptors

Malnutrition is a significant health burden that negatively impacts health outcomes and resources. It disproportionately affects rural communities where access to healthcare facilities, highly trained practitioners, and resources are already limited, and malnutrition is unfortunately underdiagnosed. Nutrition-focused Physical Exam (NFPE) is a critical component of the nutrition care process (NCP) used for identifying malnutrition in patients. Training was provided to rural nutrition preceptors of a coordinated program (CP) in dietetics using didactic and hands-on simulation training to reinforce learning, with additional guidance on how to assess student competency while performing a NFPE using the interactive Nutrition Specific Physical Exam Competency Tool (INSPECT) available to educators.

The invitation to participate in the NFPE training was shared with nutrition professionals who were actively serving as preceptors to the CP in dietetics at a University that serves rural communities. Participants were recruited by invitation through email and social media. The training included an informative presentation on malnutrition, NFPEs, and the INSPECT tool. Demonstration was provided, then participants were put into groups of three: one participant filled the role as the patient, one as a student completing the NFPE, and one as the preceptor evaluating the student. Each group practiced NFPEs while simultaneously utilizing INSPECT to practice evaluating student competency. Pre- and post-intervention surveys were collected anonymously to measure changes in self-efficacy of NFPEs, malnutrition diagnoses, and changes in self-efficacy for evaluating student competence while performing NFPEs.

Seventeen rural preceptors participated in the training. Simulation-based group learning was effective at improving preceptors' self-efficacy in using NFPEs and in evaluating student competency; Cohen's d was > 1.0 while p was < 0.05 for all items. Participants reported they would make changes to their current practice by implementing or increasing their use of NFPEs when completing nutrition assessments.

Simulation training significantly increased the self-efficacy of preceptors working with dietetic students completing NFPEs during supervised practice. Expanding this training could significantly impact malnutrition diagnosis in rural communities.