Use of an outcomes research collaborative training curriculum to enhance entry-level dietitians' and established professionals' self-reported understanding of research

Expectations of students and preceptors need clarification 

Student responses regarding the research writing proposal assignment were very positive. Students thought that the assignment met the objectives well. Furthermore, students expressed that they gained much appreciation for research from this assignment. Our finding is supported by the findings of Dooley and colleagues, who found that involvement of students through all phases of the project allowed them to gain an awareness of the entire research process ((8)). Some students expressed concern for a lack of guidance with the organization and orchestration of responsibilities. In response, we will develop a suggested schedule of activities, the purpose of which is to assist future students with time management and completion of tasks/activities between assignment due dates and to alert preceptors regarding what they can expect from students and when.

Results of the preceptor questionnaire showed that clearer expectations were needed and yielded suggestions for preoutcomes project preceptor training. As a result, in upcoming years University of Missouri–Columbia faculty will meet with the outcomes research preceptors during the summer before their involvement to discuss project ideas, course objectives and expectations, and student responsibilities, and to provide the preceptors with the fall semester outcomes research course syllabus along with the timeline of events.

Limit geographical distance 

The geographical distance between students and preceptors emerged as a reoccurring topic of concern in both the student questionnaire and the preceptor questionnaire responses. The distance between the two parties (two projects' facilities were more 100 miles from campus) made it difficult for students to take an active role in data collection and was an obstacle to timely communication. A significant change to the future outcomes research curriculum is that projects will only be conducted in facilities within a 40-mile radius of the University of Missouri campus.

Additional in-class time is necessary 

The fall 1999 research class, NS 303, met for 1 hour per week; however, the newly approved outcomes research class, ″NS 313L, Research in Dietetics,” will meet for 2 hours per week. This will allow topics to be discussed at a more in-depth level.

Porter and Matel ((10)) found that students of dietetics need experience in finding evidence quickly and efficiently. The student questionnaire supported this and disclosed that references and resources made available to them were not frequently read or used. A lecture will be developed on how to effectively use a literature reference, and a course packet containing assigned readings with research examples will be created and compiled for outcomes research courses in the future.

The student questionnaire revealed that students did not fully understand the concepts of basic vs applied vs clinical research. The basic science observation assignment was designed to help students gain an appreciation for basic research, whereas the participation in clinical research assignment was developed to help them gain an appreciation for clinical research. In future semesters, clearer explanations of the concepts, as well as their interrelatedness, will be given. Additionally, students responded that they did not learn much or gain appreciation for clinical research via the participation in clinical research assignment. This assignment, which took advantage of a rare opportunity offered by clinical research faculty, will be deleted from future course syllabi. Recruiting subjects can be a very challenging activity; the students simply lacked the research maturity to perform optimally or even to appreciate the experience. In place of this assignment, more time will be spent having the students read clinical nutrition research articles and discussing in them in class.

Students thought they had only poor to fair ability in completing forms for the IRB. In the 1999-2000 academic year, faculty lectured students on the duties of the IRB and the researcher's responsibilities. However, only the faculty and graduate assistant actually completed the IRB forms; the students were not fully involved in this process. This finding is consistent with that of Guyer and colleagues, who found that 76% of respondents to his survey were not confident and indicated a need for additional training in working with human protection committees ((11)). In response to this concern, future outcomes research courses will provide a similar lecture on the IRB; however, the students will be required to actually complete the IRB forms. On the instructor's evaluation and any necessary corrections, the proposal forms will be submitted to the IRB for approval.

Although a prerequisite to the course included a basis statistics course, another problem identified was unfamiliarity with computer statistical analysis programs. This finding is consistent with those found in the literature [1], [4], [11], [12], [13], [14]. To help overcome this obstacle, we identified an information technology resource at University of Missouri–Columbia that offers free mini-courses to University of Missouri–Columbia students on the use of statistical analysis software.

Limit scope of project 

An obstacle encountered by some students was the perceived lack of motivation and/or time on the part of the preceptor. Preceptors, however, thought that the projects were difficult to complete because of the scope and complexity of the projects. This problem may be lessened if projects are less intricate. Although faculty were involved in helping preceptors/students to focus their projects; we were a bit ″green” too.

Schiller and Moore identified 10 guidelines for success in completing an outcomes project ((15)). One guideline was ″begin small and expand. In the beginning, plan studies that involve about 25 patients or that can be finished in 3 or 6 months” ((15)). Hynak-Hankinson and colleagues support this finding, and said that educators can ″prioritize research projects innovating a shorter length of time for data collection and immediate payoff through application” ((16)). Some of the proposals undertaken during the 1999-2000 academic year were complex and required much time from the preceptor.

Another guideline for success cited by Schiller and Moore was to choose manageable problems in which one has control ((15)). A few of the proposals required the collection of data that could not be realistically obtained because of either lack of resources or use of services not within the control of the preceptor. Rinke and Berry ((17)) give further support, finding that dietitians need to ″demystify” research by ″learning how to design studies that are relatively simple and easily incorporated into the daily clinical routine.”

The preceptor questionnaire asked preceptors what barriers were encountered in initiating and implementing the research proposal and what University of Missouri–Columbia could have done to better facilitate them. Preceptors cited time, funding, and difficulty in coordinating projects with other disciplines as barriers to participating in research. Specific responses included lack of funding for the microbiology lab, should have met with IRB sooner, and getting the MD to order the lab work. Numerous sources support this finding [1], [5], [6], [11], [13], [18], [19], [20], [21]. The survey by Eck and colleagues ((1)) reported that 15 of their 30 respondents found lack of time, funding, and/or adequate staff as the reasons for not conducting research. Similarly, Guyer and colleagues ((11)) reported that 67% of their respondents stated that lack of resources and financial support impeded their efforts. Rose ((22)) also found major constraints to be limited resources, lack of personnel, financial constraints, and minimal administrative support and resources. Splett ((23)) points out that a synergistic relationship between RDs and other healthcare team members must exist to achieve outcomes. As a result of the 1999-2000 test-pilot opportunity, both the instructor and the graduate assistant will be better equipped to determine the feasibility of proposed outcomes research projects. The studies developed and implemented in future outcomes research courses will be more realistic.

Practice, practice, practice 

The students felt fairly confident in their ability to interpret figures, charts, and tables from a research article. However, short-answer responses indicated that students did not feel comfortable in their ability to analyze and interpret their own data or in their ability to represent it graphically. Prerequisites for University of Missouri–Columbia's dietetic program include a statistics course; however, the questionnaire and the meetings with students indicated that students did not know how to apply the information they had learned in their statistics course. Numerous studies support this need for additional training in the statistical analysis of data and find that the concepts of research are taught in separation from practice and that students often do not have the opportunity to integrate research activities into daily practice [4], [9], [10], [11], [12]. In future outcomes research curriculum, students will receive additional training in analyzing and interpreting data and in applying basic statistics. The new 2-hour format of NS 313L will allow more time to accomplish these activities.

Students rated their ability to critique a research article between fair ability to good ability. Although this rating is above average, we would like to see the rating for this essential skill increase to a higher level. New lectures and activities practicing how to interpret the literature will be added to the future outcomes research curriculum.

Introduce outcomes research earlier within the coordinated program curriculum 

The majority of students (nine of 14) thought that outcomes research should be introduced into the dietetics program during their first year; therefore, introductory outcomes research lectures will be given in the nutrition therapy course during the second semester of the first year of the program.

Preceptors' participation outcomes project was positive 

The preceptor questionnaire responses showed that preceptors experienced an increase in knowledge and confidence regarding outcomes research as a result of their involvement in this project. Two of the four preceptors reported that this project was the first outcomes research project they had ever been involved with, one preceptor had been involved with one other outcomes research project during her career, and the fourth respondent reported having worked on two other outcomes research projects (excluding our project). Most of the preceptors thought that their confidence increased from minimal to fair, and although three of the four preceptors noted that they eventually would have become involved in research without the use of students, they also commented that working with University of Missouri–Columbia students helped them to initiate and complete a project. The preceptors also indicated that the preferred route to obtaining research skills was to work with an experienced researcher or mentor, and the majority of preceptors (three of four) thought that the University of Missouri–Columbia provided them with adequate resources and support. These findings are consistent with those of Eck and colleagues ((1)). Of all the activities in which the preceptors were asked to participate, questionnaire results indicated that the process of proposal development was the most beneficial in learning about outcomes research. Interestingly, this may also indicate or explain why some of the students' proposals were unrealistic in their scope: this was the area in which the preceptors were weakest and learned the most themselves.

Faculty/graduate assistant observation and student performance highlights 

We learned a great deal about the teaching methods and strategies required to successfully implement this outcomes research curriculum. We offer the following suggestions, based on our observations and experience with this curriculum.

Devote considerable time to individual meetings 

There is a need for considerable individual student group attention and encouragement. At the outset of the semester, students were not accomplishing tasks in a timely manner mainly because of procrastination, but also because of fear of engaging in the unknown, so the graduate assistant began establishing weekly half-hour meetings to evaluate their progress and help problem-solve when necessary. Subsequently, we saw great improvement both in the amounts of work accomplished and in their attitudes.

Flexibility is a must 

Owen and Rinke ((24)) suggest that dietetics education programs need to be flexible and responsive to the changing needs of society. Similarly, we learned that flexibility is of the utmost necessity because each group, preceptor, and facility progresses at different rates. Regular meetings and conference calls were conducted with students and preceptors throughout both semesters to ensure that activities were being completed and information was being gathered. Additionally, when certain aspects of the methodology described in the students' proposals can not be carried out as planned because of logistical constraints (eg, acquiring adequate sample size in the time allowed by a semester system), the instructor must be flexible and creative in helping the students adapt their project within the constraint while not compromising the overall experience.

Passionate faculty and dependable graduate students are imperative 

Having faculty who possess a passion for research and the future of the dietetics profession and who can create an environment that fosters student involvement in research activities (eg, their own independent research program and/or laboratory) is vital to the success of this curriculum. Although this curriculum instructor's research experience is primarily in the basic sciences, good research is good research. The instructor was able to provide students with practical advice related to proposal writing, data analysis, and data reporting/presentation. For example, in the fall semester a lecture entitled ″The Anatomy of a Research Article” offers an insider's look into the process of publication from start to finish. Furthermore, assigning a dependable, mature RD graduate assistant to this two-course curriculum is imperative for its success because of the investment of time and labor required in supporting the needs of such a diverse group with limited research skills and experience. This graduate assistant does not necessarily need to have research experience but does need to be willing to learn, to be equipped with a tenacious spirit well-suited for maintaining communication with preceptors and students, and to have an understanding of basic statistical analyses and hypothesis testing.