A Systems Thinking-Informed Redesign of Emergency Remote Dietetic Internship Training: Supporting Nutrition Care...

Nutrition care process (NCP) competency is foundational to dietetic education and is traditionally acquired through face-to-face clinical training. Following the severe earthquake in Türkiye in January 2023, which disrupted face-to-face education, a remote teaching model informed by systems thinking was implemented to ensure the continuity of clinical competency development for dietetics interns. This study aimed to evaluate the effect of a redesigned learning model, informed by systems analysis and modelling, in fostering NCP competency development during emergency remote teaching (ERT).

This quasi-experimental comparative study included 17 final-year dietetics interns: emergency remote teaching group (ERT-G; n = 8) and internship group (INT-G; n = 9). Systems thinking tools, specifically the Iceberg Model for systems analysis and stock-and-flow diagrams for systems modelling learning processes, informed the redesign of the educational intervention. The ERT-G received structured video-based feedback on simulation practice, while the INT-G completed traditional face-to-face clinical internships. Interns' competencies were assessed using objective structured clinical examinations (OSCEs) aligned with NCP competencies.

The ERT-G significantly outperformed the INT-G in diet history (p = 0.015), nutrition care planning (p = 0.009), understanding the client narrative (p = 0.029), and planning for the next interview (p = 0.016).

These findings suggest that systems thinking tools can provide a valuable framework for designing rapid and adaptive educational responses during periods of disruption. When integrated with structured video-based feedback on simulation practice, this approach appears to support NCP competency acquisition and offers a promising strategy for sustaining clinical training in ERT contexts.