research topics in clinical nutrition and dietetics

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Nutrition is the organic process of nourishing or being nourished, including the processes by which an organism assimilates food and uses it for growth and maintenance.

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Looking to the future: Agendas, directions, and resources for nutrition research

Affiliations.

• 1 School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, Ohio, USA.
• 2 Translational and Clinical Research Centers, Massachusetts General Hospital, Boston, Massachusetts, USA.
• 3 Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
• 4 Institute for Translational Medicine Clinical Research Center, University of Chicago, Chicago, Illinois, USA.
• PMID: 38667339
• DOI: 10.1002/ncp.11154

The development and progression of nutrition as a scientific field is ever evolving and complex. Although the history of nutrition research began by exploring specific food components, it has evolved to encompass a more holistic view that considers the impact of dietary patterns over time, interactions with the environment, nutrition's role in disease processes, and public policy related to nutrition health. To guide the future direction of nutrition science, both federal and other professional organizations have established agendas and goals. The Strategic Plan for National Institutes of Health Nutrition Research outlines four goals and five cross-cutting research areas that are priorities to explore between 2020 and 2030. Similarly, the American Society for Parenteral and Enteral Nutrition and other governmental and professional organizations have identified priority areas in their research agendas. Rigorous research studies are needed to explore these areas of interest while also considering practical implementation strategies for translating research into practice. Nutrition clinicians are uniquely positioned to lend expertise in the areas of research design, implementation, advocacy and evidence-based practice; there are numerous resources to support practitioners in these endeavors.

Keywords: federal nutrition research; nutrition policy; nutrition research; precision nutrition; translational science.

© 2024 The Authors. Nutrition in Clinical Practice published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.

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Trends, challenges, opportunities, and future needs of the dietetic workforce: a systematic scoping review

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Merran Blair, Lana Mitchell, Claire Palermo, Simone Gibson, Trends, challenges, opportunities, and future needs of the dietetic workforce: a systematic scoping review, Nutrition Reviews , Volume 80, Issue 5, May 2022, Pages 1027–1040, https://doi.org/10.1093/nutrit/nuab071

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Issues related to nutrition and health are prominent, yet it is unclear if the dietetics workforce is being used optimally.

Trends, challenges, opportunities, and future needs of the international dietetic workforce are investigated in this review, which was registered with Open Science Framework (10.17605/OSF.IO/DXNWE).

Eight academic and 5 grey-literature databases and the Google search engine were searched from 2010 onward according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Of 2050 articles screened, 184 were eligible for inclusion.

To chart data, a directed content analysis and a constant comparison technique were used.

The following 13 themes were identified: 1) emerging or expanding areas of practice; 2) skill development; 3) economic considerations; 4) nutrition informatics; 5) diversity within the workforce; 6) specific areas of practice; 7) further education; 8) intrapersonal factors; 9) perceptions of the profession; 10) protecting the scope of practice; 11) support systems; 12) employment outcomes; and 13) registration or credentialing.

The dietetics profession is aware of the need to expand into diverse areas of employment. Comprehensive workforce data are necessary to facilitate workforce planning.

A dietitian “is a professional who applies the science of food and nutrition to promote health, prevent and treat disease to optimize the health of individuals, groups, communities and populations.” 1 To use the professional title dietitian in many countries, including the United States, Canada, Australia, New Zealand, and the United Kingdom, requires a minimum of a bachelor’s degree qualification, in addition to a minimum of 500 supervised practice hours. This is in contrast to the title of nutritionist , which is less defined in many countries, with no minimum level of education; however, professional organizations suggest undergraduate degrees in nutrition science are preferred. 2 Dietitians can register with professional bodies in their country of practice, which allows them to treat individuals under various health insurance schemes and in a range of settings. In Australia, dietitians are given the title of Accredited Practicing Dietitian, in the United Kingdom, Canada, and New Zealand, the term is registered dietitian; in the United States, a qualified and registered dietitian is referred to as registered dietitian-nutritionist. For inclusivity, the term dietitian is used in this article.

Current rates of diet-related chronic disease are high, 3 and issues related to sustainable food production 4 and food security 5 , 6 are receiving more attention and requiring strategic action. Dietitians are health professionals who are well placed to address these issues 1 ; however, it is unclear if this workforce is being used optimally. Current dietetic workforce data are limited across the world and there is no objective evidence that gives a clear indication of employment rates of graduates 7 or whether the dietetics workforce is meeting population nutrition needs. 8 In the United Kingdom, approximately two thirds of dietitians work within the publicly funded National Health Service, but employment information is lacking on the one third who do not. 9 In the United States, job growth for dietetics is predicted to be higher than for other professions 10 ; however, some dietitians report leaving the profession for higher pay in alternative fields or being unable to find work. 11 In Australia, workforce supply is perceived to be greater than demand, 12 and anecdotal evidence suggests graduates struggle to find employment.

The goal of workforce development is to ensure that workforce members are able to obtain a sustainable livelihood, in addition to using the labor to achieve organizational goals that meet the needs of society. 13 , 14 Because of the changing nature of healthcare delivery 15 , 16 and consumer needs, 17 , 18 employment opportunities for dietitians are rapidly evolving. It is important that such changes be regularly assessed 19 to ensure the profession remains effective and relevant. The dietetic profession is aware of the need for planning, and comprehensive studies have been completed in both the United States 20–22 and the United Kingdom, 9 with plans underway for similar work in Australia 23 to explore the future of the dietetics profession. Work in the United Kingdom resulted in 16 recommendations for development of a dietetic workforce strategy that included increasing the visibility of the profession and preparing dietitians for more diverse roles through strategic leadership. 9 In the United States, researchers analyzed societal-change drivers and how they might affect the growth of the dietetic profession. 20 , 21 They sketched out 4 possible scenarios of the future the profession may face, depending on how it responds to these change drivers. 22 Although these projects included a systemic review 20 and an environmental scan, 9 which informed subsequent research, no systematic reviews addressing trends within the dietetic workforce have been published.

Our purpose in conducting this systematic scoping review was to investigate trends, challenges, opportunities, and future needs of the global dietetic workforce from a diverse range of literature. This information can be used to inform future workforce development strategies and to guide training priorities for the current and future international workforce. This will help ensure that members of the dietetic workforce are well placed to find employment and effectively improve the nutritional outcomes of our population.

This systematic scoping review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist 24 and with reference to the JBI   Manual for Evidence Synthesis . 25 This review was registered with the Open Science Framework ( 10.17605/OSF.IO/DXNWE ). A scoping review was selected to be conducted in preference to synthesis approaches to capture the depth and breadth of the literature on the broad exploratory research question. 25 Grey literature was included because it has the benefit of contributing contemporary material from a broad range of stakeholders, 26 and publication delays in academic research can mean that results are indicative of past events, rather than current or future.

The following databases were searched on February 6, 2020, in in consultation with the subject specialist research librarian: Ovid MEDLINE, CINAHL Plus, Proquest Social Science Premium Collection, Scopus, and Business Source complete. Searching was also conducted in the following grey-literature databases: Open Grey, Grey Guide, MedlinePlus, Grey Literature Report, and Mednar; and thesis searching was conducted on Trove, Proquest Dissertations & Thesis Global, and Dart Europe E-Theses Portal. All searches were time restricted from January 2010 to February 2020 to capture information about the contemporary workforce from the past decade, rather than historical, outdated data. Only publications in English were included. Inclusion and exclusion criteria were predetermined on the basis of the PICOS model (ie, participants, interventions, comparisons, outcomes, and study design) ( Table 1 ). Search terms ( Table 2 ) were used with appropriate variations according to the functionality of each database. All results were uploaded to Endnote X9 and then to Covidence systematic review software. 27 Title and abstract screening, followed by full-text screening, was completed in duplicate by 2 authors (M.B. and either L.M., S.G., or C.P.). Conflicts were discussed until consensus was reached.

PICOS criteria for inclusion of studies

Abbreviation: CPD, continuing professional development.

Search terms used for the scoping review exploring trends, challenges, opportunities, and future needs of the dietetic workforce

Grey-literature searching, using the search terms listed in Table 2 , was conducted using the Google search engine in February 2020. The first 10 pages of results (ie, the first 100 hits) were screened, initially via the Google search screen, then potentially relevant sites were viewed in full. 26 Reasons for exclusion were noted, and included pages were saved in PDF format for data extraction. Screening of results from the Google search was conducted by 1 researcher (M.B.). Duplicate screening was deemed unnecessary because consensus on eligibility had been reached during database screening and conflict resolution.

Data charting of included papers was completed in a spreadsheet and included year of publication, author, country where the research was conducted or the article was published, type of article, type of study, and, if applicable, research methods, population, and number of participants. In addition, a directed content analysis 28 , 29 was conducted whereby themes were deductively generated under the formative categories of 1) trends (namely, ways the workforce was developing or changing), 2) opportunities (ie, ways to achieve further development), 3) challenges (ie, obstacles to development), and 4) future needs (ie, aspects needed to strengthen the workforce) and recorded in the spreadsheet. This structure was formulated by the researchers with reference to existing research indicating that the dietetic workforce is in a state of flux and in need ofplanning. 9 , 20–22 . For the second stage in the data charting process, we used a constant comparison method 30 whereby common recurring themes were identified, within the formative categories, and these became the results of the review. Data charting was conducted by 1 researcher (M.B) with a subset of 10% (in total) charted by another researcher (either L.M., S.G., or C.P.) and cross-checked for comparison, with no major errors or omissions identified. Critical appraisal of individual sources of evidence was not conducted, as is typical of scoping reviews. 24 The frequency of themes across studies was collated and a visual representation of the frequency of categories was developed on the basis of these data ( Figure 1 ).

Results of the scoping review exploring trends, challenges, opportunities, and future needs of the dietetic workforce, in descending order of commonality. Larger circles indicate the topic was referred to more often; however, this is a graphical representation only and circles are not to scale. Items listed in boxes are subcategories. Linking of circles indicates the path from most commonly to least commonly mentioned topic: emerging or expanding areas of practice (n=52); skill development (n=43); economic considerations (n=31); nutrition informatics (n=23); diversity within the workforce (n=20); specific areas of practice (n=20); additional education (n=17); intrapersonal factors (n=9); perceptions of the profession (n=9); support systems (n=5); protect the scope of practice (n=5); employment outcomes (n=3); registration and credentialing (n=3).

A total of 2050 articles were screened; of these, 184 were included in the scoping review ( Figure 2 ). Characteristics of the included articles are collated in Table 3 , and a comprehensive list of included articles is provided in Table S1 in the Supporting Information online. The following 13 themes were identified and are listed here in descending order of commonality: 1) emerging or expanding areas of practice; 2) skill development; 3) economic considerations; 4) nutrition informatics; 5) diversity within the workforce; 6) specific areas of practice; 7) additional education; 8) intrapersonal factors; 9) perceptions of the profession; 10) protecting the scope of practice; 11) support systems; 12) employment outcomes; and 13) registration or credentialing ( Figure 1 ). Subcategories were also identified under some themes.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of included studies in the systematic scoping review

Characteristics of articles included in the systematic scoping review

Abbreviations: JAND, Journal of the Academy of Nutrition and Dietetics; JADA, Journal of the American Dietetic Association.

Country where the research was conducted, or the article published.

Includes Australia and New Zealand; Australia and United Kingdom; Australia, United Kingdom, and United States; Ireland and United Kingdom; Sweden, Wales, and United States.

Includes China, Ghana, Israel, Italy, Malaysia, South Korea, Sudan.

Includes theses, abstracts, and 2 government reports.

Original research, excluding abstracts or theses.

Includes environmental scan, case study, Delphi survey, policy discourse analysis, nonrandomized controlled trial, prospective cohort.

Emerging or expanding areas of practice

A total of 51 different emerging or expanding areas of practice were identified ( Table S2 in the Supporting Information online). These were highlighted as employment opportunities to expand the scope of the profession 31 , 32 and ways in which dietitians can contribute valuable skills to benefit businesses and individuals. 31 , 33 , 34 Emerging areas were spoken of as a future need, because if dietitians did not fill these roles, they would be filled by other, potentially less qualified, individuals. 35

Skill development

A total of 21 different skills were identified (( Table S2 ) as both opportunities and future needs. Skill development was deemed to be a means by which dietitians would be able to “strengthen their ability to offer food and nutrition solutions in a wide range of situations.” 22 Clinical skills such as integrative and functional medicine 36 and nutritional genomics 37 were noted to be of increasing public interest. Skill development in these areas were suggested in order to meet the changing needs of consumers. 36 , 37 Social media skills were identified as a means to champion evidence-based nutrition information and to advocate for the profession. 38 Areas such as business skills, 22 collaboration, 39 client/customer focus, 40 computer literacy, 40 and financial management 41 were highlighted as skills desired by organizations. Sustainable food systems practices were identified as areas where dietitians can offer solutions to meet the needs of consumers and organizations. 42 It was also suggested that the profession encourage students to have dual degrees to strengthen skills in business and management. 22

Economic considerations

Four subcategories were identified relating to economic considerations: staffing ratios, supply and demand, compensation and benefits, and recruitment and retention.

Staffing ratios.

Inadequate staffing ratios were common 43–49 and described as a challenge because they may result in worse patient outcomes, 45 increased healthcare costs, 44 and increased staff turnover due to burnout. 47 In addition, dietitians were more commonly found in metropolitan areas, 49 which potentially results in lack of equitable access for individuals needing dietetic input. 48

Supply and demand.

Predictions of supply and demand varied between countries and over time. 19 , 20 , 50–53 The US Bureau of Labor Statistics predicted job growth to be “much faster than average” at 11% between 2018 and 2028. 10 Supply and demand were seen as dynamic, requiring ongoing assessment, and fundamental to workforce success. 21 , 22 , 54 An undersupply of dietitians was viewed as an opportunity for the existing workforce, resulting in higher pay rates. 19 Conversely, it was also seen as a challenge that could leave positions open for other professions, which would erode the potential economic advantage. 19 Attrition rates due to retirement were described as a challenge 20 that could result in a lack of qualified dietitians to fill senior positions. 19

Compensation and benefits.

Trends in compensation and benefits varied over time, sometimes keeping up with inflation 55 and sometimes not, 56 and a drop in wages was noted in the United States between 2015 and 2018 from USD 30.62/h to 30.45/h. 11 Higher wages were associated with higher education levels, as were specialty certifications, years of experience, and budgetary responsibility. 11 , 56 Direct client contact was associated with lower rates of pay, and supervisory roles were associated with higher pay rates. 11 , 56 Highest wages were reported in the “areas of food and nutrition management, consultation and business, and education and research.” 11

Some dietitians reported not working in dietetics because they found “a higher paying job outside of the field.” 11 Identified future needs included professional associations supporting members to achieve “recognition, respect and remuneration,” 56 creating job opportunities, 55 and giving members confidence in salary negotiations. 55 , 56

Recruitment and retention.

Opportunities reported to enhance staff retention included the chance for dietitians to specialize or undertake research, 57 opportunities for learning, 58 , 59 positive relationships with others (ie, staff and patients), 58 , 59 a supportive workplace culture, and recognition of the role of the dietitian from other staff members. 59 Factors reported to strengthen recruitment were enhanced job security and closeness of the position to home. 58

Nutrition informatics

Nutrition informatics was seen as a growth area 60–62 offering many opportunities for the dietetics profession. The primary benefit described was the gathering of large data sets that could be used to improve efficiency of interventions and enhance patient outcomes. 62–65 This area also was noted as a challenge because the dietetics profession was not adequately engaged in this field 66 and, at best, was moderately prepared. 63 , 66 It was reported that dietitians need to have greater input into nutritional informatics to ensure the systems developed are of benefit to the profession 62 , 64 and are in line with the Nutrition Care Process. 64 , 65 If dietitians were not involved in the development of nutrition informatics, studies suggested that another profession would fill these roles, 63 and the systems may not be fit for the purpose of dietetics. 64 To enhance dietetic involvement in nutrition informatics, future needs identified were training and professional development, 64 , 66 including certification, 64 leadership, 64 and mentoring. 63

Mobile health apps .

In the literature we reviewed, nutrition apps were seen as a valuable tool to assist in patient care 65 and, if used in conjunction with dietetic counselling, could enhance the client-dietitian relationship. 67 It was reported that dietitians want access to credible, well-designed apps that can be integrated into current practice. 67 However, mobile health apps (aka, mHealth apps) were reported to be poorly designed for collaborative treatment with a dietitian. 68 They were noted to have the potential to increase quality and efficiency of healthcare 68 by gathering real-time, noninvasive data; however, access to these data was reported to be limited. 69

Training, education, and advocacy on the part of dietetic associations were identified as future needs to ensure greater engagement with use of apps by dietitians. 70 In addition, greater collaboration among app designers, dietetic professional associations, and dietitians 67 was identified as necessary to ensure apps are optimal for use in dietetic practice. mHealth app development was identified as a growth industry and it was felt that if dietitians fail to be involved, they may leave these roles open to other, less qualified individuals. 71

Diversity within the workforce

Diversity was described as a challenge, with the dietetics profession being predominately homogenous (female and White) and not representative of the broader population. 72–74 This was reported to create a divide between the profession and the individuals they serve. 72 In addition to sex, gender 73 and race, 74 the need for diversity with reference to age, religion, socioeconomic status, 41 and disability 75 were also identified. Suggested ways to increase diversity included peer mentoring and targeted approaches to recruit more diverse students. 76 , 77

Specific areas of practice

Aspects relating to 7 different areas of practice were described. These included: high staff turnover in rural and remote practice, 78 low patient attendance rates in private practice, 79 the need for interprofessional support in primary health care, 80 the benefits of expanding food-service initiatives within the school setting, 81 and the challenges faced by academic dietetic educators 82 and sports dietitians requiring advocacy for services for college-level athletes. 83

Additional education

Advanced credentialing..

Dietitians were reported to have higher levels of advanced credentialing compared with other professions, 19 with many existing and planned advanced credentials available in the United States. 41 , 84 Opportunities associated with advanced credentialing were identified as expanding an individual dietitian’s scope of practice 84 and recognition of dietitians as leaders in food and nutrition by external stakeholders. 54 Advanced credentialing was also reported to lead to more rewarding job opportunities, 85 particularly in growth areas such as gerontology and chronic disease management. 86 Increased wages were a reported outcome of advanced credentialing, 51 and advanced credentialing was seen as beneficial to the profession because it resulted in more efficient and cost-effective interventions. 85

Challenges identified that are related to advanced credentialing included a previous lack of clearly defined pathways, 87 although many pathways were listed in a more recent article. 84 Residency programs were noted to be an effective method of delivery that incorporated practical learning 85 , 87 , 88 ; however, availability of funding for these was described as inconsistent 87 and sometimes acquired from multiple sources. 83 In addition, the general public were reported to lack understanding of the benefits of advanced credentialing 87 and employers yet to value or demand these credentials. 19

Extended scope of practice.

Extended scope of practice is the recognition of an additional skill that is outside of the defined scope of practice of a healthcare professional. 89 For dietitians, this can include activities such as blood glucose testing, adjusting insulin doses, inserting nasogastric tubes, 89 tube feeding management, 90 , 91 gastroenterologic treatment management, 92 and, depending on local legislation, prescribing of pharmaceuticals. 89 , 93 , 94

Dietitians in extended-scope-of-practice roles were noted to contribute to reduced healthcare costs resulting from streamlining of services and efficient patient-care management. 89–92 , 95 This was identified to be a result of fewer healthcare visits, 89 , 92 , 95 shorter waiting times, 91 and reduced hospital admissions. 90 Opportunities were reported to include an enhanced professional profile, with dietitians in extended-scope roles perceiving increased professional status 90 and recognition. 91 They also reported increased job satisfaction due to working to the full scope of their practice, and sharing the experience with other dietitians through a community of practice. 91 Acknowledgment and appreciation of advanced skills by the healthcare team were thought to result in enhanced working relationships. 90 , 91

The challenges associated with extended-scope roles related to the lack of strategic planning, with these roles reportedly forming out of unfilled vacancies. 90 To assist with more strategic planning, the development of a framework that incorporates the available options for extended scope of practice, 9 in addition to clearly defined learning programs and evaluation strategies, 91 was described as future needs. In 1 instance, it was reported that an extended-scope role caused conflict with nutrition nurse specialists because of the crossing of professional boundaries. 91 Supportive infrastructures were noted as essential for the creation and maintenance of these roles, such as clinical governance and stakeholder engagement. 91

Intrapersonal factors

Job satisfaction..

Trends in job satisfaction indicated that dietitians were moderately 96 or slightly 97 satisfied with their jobs, with dietitians in clinical positions reporting the lowest scores. 98 Age and experience were associated with higher levels of job satisfaction. 99 Key factors reported to enhance job satisfaction included: opportunities for promotion 96 , 97 , 99 , 100 and professional development, 100 flexibility in work hours, 100 a dynamic team environment, 100 a positive work atmosphere, 97 and higher salaries. 97–99 Other elements that were identified as increasing job satisfaction included “reward and recognition” 100 and “autonomy, meaning, recognition and respect.” 98 Issues with the physical environment and access to resources, 100 in addition to “poor perception of professional image,” 99 were reported to have a negative effect on job satisfaction.

Job satisfaction was a challenge, due to the reported costs associated with staff turnover, absenteeism, and reduced productivity 96 that occur when satisfaction levels are low. It was also seen as an opportunity, because increased job satisfaction was reported to lead to improved patient or customer satisfaction. 98

Stress and burnout.

Trends indicated that although dietitians had lower levels of burnout than other health professionals did, they still had moderate levels of emotional exhaustion. 101 In addition, their sense of personal accomplishment was only moderate, although this increased with age and years of experience. 101 The main challenge associated with stress and burnout was the potential for negative health consequences for the individual and decreased job performance, resulting in negative impacts on clients and organisations. 101

Challenges identified that increased stress and burnout were a perceived lack of respect from other healthcare professionals, due to a lack of understanding of the dietitian’s role. 102 In addition, unrealistic expectations as to what dietitians can achieve with limited time and resources and the lack of recognition associated with being a preceptor were reported as challenges. 102 Expectations that dietitians “conform to certain ideals, including thinness” were perceived to increase stress and burnout. 102 Future needs reported included additional training in “resilience, mindfulness and empathy,” as well as interprofessional approaches to combating stress. 102

Preparedness for practice.

Preparedness for practice was perceived as a challenge because of a lack of data on emerging areas of practice, 7 leading to difficulty in tailoring curricula toward employment opportunities. In addition, research specific to the workplace, involving graduates and employers, was identified as lacking. 7 Graduates reported feeling underprepared for new and emerging roles and were overwhelmed by the competition for traditional job opportunities. 103 Future needs identified included comprehensive graduate employment outcome data 7 and a realignment of course curricula to better prepare graduates for emerging roles. 103

Perceptions of the profession

Although the role of the dietitian was thought to have become less confusing to the public, 104 awareness of what a dietitian does was described as low. 105 Dietitians were reportedly seen as simply prescribers of diets, 105 , 106 and the general public had difficulty distinguishing between dietitians and other professions, such as naturopaths. 107 The level of education required to be a dietitian was reported to be poorly understood, 107 and there was an identified lack of clarity of the distinction between dietitians and nutritionists. 9 This was thought to result in a dilution of the credential and confusion regarding the dietitian’s role in healthcare. 9 As a profession, dietitians were reported to desire greater visibility and credibility and a clearer public profile that acknowledges them as experts in nutrition. 9 , 108

Dietitians also wished to be seen as a health professional who should be visited regularly, much like a dentist. 9 , 109 A transformation was reported to be occurring from the dietitian being a provider of information to being a provider of counselling-based treatment. 107 This was identified as an opportunity, because the public perceived treatments involving the transfer of information as requiring only short-term intervention, whereas they viewed a therapeutic, counselling style approach as a long-term strategy. 107 Both the dietetic profession and the public were reportedly struggling to adapt to this change from “information giver” to counsellor. 107

Strong partnerships with physicians provided opportunities, because referrals from them increased the likelihood of patients engaging in ongoing treatment. 107 In addition, physicians acknowledged that their own nutrition education is limited and they had positive opinions of the training and experience of dietitians. 107 Other opportunities identified included the work of special-interest groups with stakeholders relevant to their topic areas and incorporating a broader range of placement opportunities with a broader range of stakeholders. 9

Although dietitians felt they have much to contribute to the healthcare sector, they did not feel they had a voice that can be heard. 9 Professional associations were seen as the key to amplifying the voice of the profession and increasing visibility. 9 Some dietitians expressed concern that their professional association was not fully recognized by consumers or other healthcare practitioners. 110

Because of increasing competition in areas involving nutrition, future needs identified included “clear and compelling communication” with consumers to champion the brand of the dietitian above other potential sources of dietary advice. 105 Although consumers reported unfamiliarity with the credentials and training of dietitians, they did not have negative perceptions, so it was noted as beneficial for professional associations to continue to increase familiarity of the dietitian “brand.” 105 From the reviewed literature, we also identified that research was needed on the public perception of dietitians and nutritionists and to find ways to collaborate to provide enhanced clarity in distinguishing the 2 professions. 9

Support systems

Mentoring or professional support..

Mentoring was reported to offer opportunities in the form of enhanced confidence 111 , 112 and competence 112 , 113 and the chance for reflective practice. 111 , 113 These opportunities were noted to lead to improved productivity for both the mentor and mentee. 111 Other beneficial professional supports included working with another dietitian, peer-support networks, professional supervision, or working as part of a multidisciplinary, multicultural team. 112 Future needs identified included experienced and passionate mentors who create a trusting relationship and provide effective feedback. 113

Communities of practice.

Communities of practice were an effective method of increasing competence 114 and confidence to change practice, resulting in workforce retention 115 and development. 114

Protect the scope of practice

Protecting the scope of practice was described as “the greatest challenge” for the dietetic profession. 116 Competition in providing dietary advice and care was described as coming from other healthcare professionals, 19 , 22 whose expertise may have some nutrition overlap, as well as from individuals without academic training. 19

Opportunities within this area include the development of a workforce that adapts to the changing needs of society and whose value is acknowledged, because this type of workforce has less need to be protective of its scope of practice. 22 In addition, the creation of a more fluid scope of practice among healthcare professionals was noted as a way to enhance interdisciplinary collaboration. 21 A shared code of conduct for nutrition science professionals was suggested as a future need, because this may help define and protect the scope of practice. 117

Employment outcomes

Data related to employment outcomes had significant limitations. A comprehensive report from Australia was based on data from 2011, 118 now a decade out of date. From this report, trends indicated that less than half (45%) of individuals with a dietetic qualification worked as a dietitian, while 41% worked in unrelated occupations. 118 Another article reported on dietitians working in the public sector in a single state of Australia (namely, Victoria), 119 making this information biased toward hospital employment. Results from a study of dietitians who graduated from a single university in Canada indicated that employment may be increasingly difficult to obtain and graduates are having to work in rural or remote areas. 120

Registration or credentialing

Challenges faced in countries that were not members of the International Confederation of Dietetic Associations were distinctly different from those faced in countries where registration and credentialing are well established. In Sudan, professionalism and standards of practice were reported to be poorly defined. 121 In Ghana, an inadequate supply of dietitians in some areas and practitioners lacking formal qualifications were identified. 122 In China, a lack of educational opportunities and a poorly defined credentialing system were reported. 123

The purpose of this review was to investigate trends, challenges, opportunities, and future needs of the international dietetic workforce, from a diverse range of sources. The literature identified is predominantly focused on emerging areas of dietetic practice and skill development to meet current and future health nutrition needs of the population. This finding suggests the profession is aware of the need to adapt its skill set to successfully create jobs and have an impact on the changing food, nutrition, and health environments.

The number and scope of articles we identified demonstrate that the dietetics profession is contemplative of its position within society and how effectively it is serving communities. The profession is aware that healthcare delivery and the food and nutrition environment are changing, and is seeking information on how to adapt to these changes. There is considerable published work designed to understand and guide the future path of the profession, 9 , 20–22 with more underway. 23 Similar to the requirement that individual dietitians reflect on their own practice, 1 the profession as a whole appears to be reflective, questioning the place of dietetics within broader contexts.

The 2 most common themes identified in this scoping review were emerging or expanding areas of practice and skill development. Both of these topics have the potential to significantly enhance workforce development. Expansion of the profession into more diverse areas will lead to greater employment opportunities for dietitians, as well as increased capacity to meet the health and nutrition needs of society. Within the identified literature, emerging roles are most commonly presented as a way to expand the influence of the profession 9 and meeting the needs of society across multiple areas of healthcare and the food system. 20 , 21 The literature does not specify if emerging roles are considered important as a way to enhance employment, such as compensating for a lack of traditional roles (eg, clinical positions). Graduate employment data are lacking globally, resulting in a dearth of information regarding supply and demand for traditional roles.

The results of this review demonstrate that the topic of emerging areas of practice has been under discussion for at least a decade. 124 Despite this, dietetic education programs continue to focus on training students for clinical hospital roles, even though the majority of graduates are unlikely to work in this area. 118 Graduates are aware of the incongruence between training programs and employment opportunities, and they identify an overemphasis on clinical dietetics skills to the detriment of business and private practice skills. 103 Dietetics training programs need to reconsider their curricula to ensure training is reflective of workforce opportunities. To do this, it will be essential first to identify employment outcomes. Once these have been identified, training programs can consider implementing more diverse placement experiences to better prepare graduates for these emerging roles. Because teaching programs must meet accreditation standards, these may also need to be redefined to encourage contemporary placement settings.

Nutrition informatics was identified as an emerging area in this study, particularly relevant in light of the recent COVID-19 global pandemic. Large data sets, which can be gathered through informatics, have been identified as a valuable resource to help rapidly develop effective nutrition treatment strategies in situations such as the COVID-19 pandemic. 125 Well-designed mHealth apps can also compliment remote healthcare (eg, telehealth), as has become common during recent pandemic-associatedlockdowns. 126 Informatics will likely continue to be a rapidly expanding area for the dietetic profession as the world adapts to new healthcare models and global trends in technology.

This review has highlighted a significant lack of published workforce data. Although professional registration bodies generally gather information about their members, not all individuals with a dietetic qualification choose to become members of these organizations. Therefore, this information does not adequately capture individuals who take on nondietetic roles, nontraditional roles, those who remain unemployed. or those who choose not to be members. The US Bureau of Labor Statistics gathers workforce data on individuals who identify as working as dietitians; 10 however, as demonstrated in the Australian context, 118 almost half of individuals with a degree in dietetics work outside of the field. In addition, these data do not capture individuals who may be using the skills acquired during their dietetic degree but do not identify their primary role as “dietitian” (eg, academics teaching in dietetic programs). Comprehensive data that track graduates over time are necessary to identify if and why the profession is losing workforce members. These data are also essential to identify the most contemporary emerging areas as well as the potential impact on health and nutrition of populations. This, in turn, could guide the development of additional education priorities, and identification of specific industries in which advocacy can be targeted to enhance employment opportunities (eg, app developers 70 ).

Although graduate outcomes data will help identify current employment opportunities in the short term, ongoing research will also be needed. To remain relevant to consumer needs, more research should focus on what end users (ie, clients, patients, and the community) require from dietitians. If this area is not addressed, it is likely that other individuals will fill these gaps, as has been the case with unqualified social media “experts” providing nutrition information. 127 In addition, knowledge of the needs of the sectors and disciplines that interplay with the food system is required to identify trends, challenges, and opportunities where dietitians may play a role. It is also worth noting that none of the themes identified within this review has been “solved,” and all areas will require more exploration and development to strengthen the position of the dietetics profession. Leadership by the international dietetics community is needed, both in accreditation and training, to ensure the profession is at the forefront of contemporary developments.

Because food and nutrition have a role to play across many contexts and they affect every individual, the potential employment opportunities for dietitians are vast. Emerging employment areas include such diverse settings as policy development, agriculture, the education sector, 84 and social media. 38 By actively expanding the available fields of employment, the profession is embarking on a journey that appears to be unique to dietitians. Without precedent from other health disciplines, it is difficult to know how best to navigate these changes. What is most important is that the conversation is initiated and work begins in implementing the changes necessary to ensure the dietetic profession remains effective and relevant in the long term.

A strength of this review was that we included an international perspective; however, the restriction in publication language may have resulted in exclusion of perspectives from non–English-speaking countries, and, therefore, their perspectives remain unknown. The scoping review format and the inclusion of grey literature also meant that a broad range of opinions was included. However, this may also be a limitation, because the results were not generated solely from high-level evidence.

The global dietetic workforce is a potentially underused resource but recognizes its own need to adapt to the changing nutrition landscape. To understand this situation better, it is essential that professional bodies gather comprehensive workforce data that track graduates over time. This will assist the profession to stay abreast of emerging roles the workforce can use to expand its reach and effectiveness.

The authors express their gratitude to the unknown reviewers of this manuscript for their generous and constructive feedback.

Author contributions: All authors contributed to conceiving the study and to screening and data analysis. M.B. drafted the manuscript, and C.P., L.M., and S.G. provided critical revision. All authors read and approved the final manuscript. No individual meeting the authorship criteria has been omitted.

Funding . M.B. was supported by a scholarship from the Department of Nutrition, Dietetics and Food, Monash University, to undertake this work.

The funder had no input into the conception, design, performance, or approval of the work.

Declaration of interests. The authors have no conflicts of interest to declare.

Supporting information

The following Supporting Information is available through the online version of this article at the publisher’s website.

Table S1 . A complete list of articles, identified through database searches and the Google search engine, that were included in the systematic scoping review of trends, challenges, opportunities, and future needs of the dietetic workforce.

Table S2 . Extended results of topics identified in the systematic scoping review

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Mindful Eating

What Is It?

Mindful eating stems from the broader philosophy of mindfulness, a widespread, centuries-old practice used in many religions. Mindfulness is an intentional focus on one’s thoughts, emotions, and physical sensations in the present moment. Mindfulness targets becoming more aware of, rather than reacting to, one’s situation and choices. Eating mindfully means that you are using all of your physical and emotional senses to experience and enjoy the food choices you make. This helps to increase gratitude for food, which can improve the overall eating experience. Mindful eating encourages one to make choices that will be satisfying and nourishing to the body. However, it discourages “judging” one’s eating behaviors as there are different types of eating experiences. As we become more aware of our eating habits, we may take steps towards behavior changes that will benefit ourselves and our environment.

How It Works

Mindful eating focuses on your eating experiences, body-related sensations, and thoughts and feelings about food, with heightened awareness and without judgment. Attention is paid to the foods being chosen, internal and external physical cues, and your responses to those cues. [1] The goal is to promote a more enjoyable meal experience and understanding of the eating environment. Fung and colleagues described a mindful eating model that is guided by four aspects: what to eat , why we eat what we eat , how much to eat , and how to eat . [1]

Mindful eating:

• considers the wider spectrum of the meal: where the food came from, how it was prepared, and who prepared it
• notices internal and external cues that affect how much we eat
• notices how the food looks, tastes, smells, and feels in our bodies as we eat
• acknowledges how the body feels after eating the meal
• expresses gratitude for the meal
• may use deep breathing or meditation before or after the meal
• reflects on how our food choices affect our local and global environment

Seven practices of mindful eating

• Honor the food . Acknowledge where the food was grown and who prepared the meal. Eat without distractions to help deepen the eating experience.
• Engage all senses . Notice the sounds, colors, smells, tastes, and textures of the food and how you feel when eating. Pause periodically to engage these senses.
• Serve in modest portions . This can help avoid overeating and food waste. Use a dinner plate no larger than 9 inches across and fill it only once.
• Savor small bites, and chew thoroughly . These practices can help slow down the meal and fully experience the food’s flavors.
• Eat slowly to avoid overeating . If you eat slowly, you are more likely to recognize when you are feeling satisfied, or when you are about 80% full, and can stop eating.
• Don’t skip meals . Going too long without eating increases the risk of strong hunger, which may lead to the quickest and easiest food choice, not always a healthful one. Setting meals at around the same time each day, as well as planning for enough time to enjoy a meal or snack reduces these risks.
• Eat a plant-based diet, for your health and for the planet . Consider the long-term effects of eating certain foods. Processed meat and saturated fat are associated with an increased risk of colon cancer and heart disease . Production of animal-based foods like meat and dairy takes a heavier toll on our environment than plant-based foods.

Watch: Practicing mindful eating

The Research So Far

The opposite of mindful eating, sometimes referred to as mindless or distracted eating, is associated with anxiety, overeating, and weight gain. [3] Examples of mindless eating are eating while driving, while working, or viewing a television or other screen (phone, tablet). [4] Although socializing with friends and family during a meal can enhance an eating experience, talking on the phone or taking a work call while eating can detract from it. In these scenarios, one is not fully focused on and enjoying the meal experience. Interest in mindful eating has grown as a strategy to eat with less distractions and to improve eating behaviors.

Intervention studies have shown that mindfulness approaches can be an effective tool in the treatment of unfavorable behaviors such as emotional eating and binge eating that can lead to weight gain and obesity, although weight loss as an outcome measure is not always seen. [5-7] This may be due to differences in study design in which information on diet quality or weight loss may or may not be provided. Mindfulness addresses the shame and guilt associated with these behaviors by promoting a non-judgmental attitude. Mindfulness training develops the skills needed to be aware of and accept thoughts and emotions without judgment; it also distinguishes between emotional versus physical hunger cues. These skills can improve one’s ability to cope with the psychological distress that sometimes leads to binge eating. [6]

Mindful eating is sometimes associated with a higher diet quality, such as choosing fruit instead of sweets as a snack, or opting for smaller serving sizes of calorie-dense foods. [1]

• A literature review of 68 intervention and observational studies on mindfulness and mindful eating found that these strategies improved eating behaviors such as slowing down the pace of a meal and recognizing feelings of fullness and greater control over eating. [8] Slower eating was associated with eating less food, as participants felt fuller sooner. Mindfulness and mindful eating interventions appeared most successful in reducing binge eating and emotional eating. However, the review did not show that these interventions consistently reduced body weight. Limitation of the studies included small sample sizes, limited durations of about 6 months or less, lack of focus on diet quality, and lack of follow-up so that longer-term success was not determined.
• A randomized controlled trial following 194 adults with obesity (78% were women) for 5.5 months looked at the effects of a mindfulness intervention on mindful eating, sweets consumption, and fasting glucose levels. The participants were randomly assigned to one of two groups: a diet and exercise program with mindfulness concepts (stress reduction, chair yoga, meditation, affirmations) or the same program but without mindfulness concepts. After 12 months, the mindfulness group showed a decreased intake of sweets and maintenance of fasting blood glucose, as opposed to the control group showing increased fasting blood glucose. [9] The research authors also evaluated weight loss with these participants, but did not find a significant difference in weight changes between the mindfulness group and control group. [10]
• A small controlled trial of 50 adults with type 2 diabetes were randomized to either a 3-month mindful eating intervention that was focused on reducing overeating and improving eating regulation or to a diabetes self-management education (DSME) intervention that was focused on improving food choices. Both groups showed significant improvements in measures of depression, nutrition self-efficacy, and controlling overeating behaviors. Both groups lost weight during the intervention but there was no difference in amount of weight loss between groups. [11]

It is important to note that currently there is no standard for what defines mindful eating behavior, and there is no one widely recognized standardized protocol for mindful eating. Research uses a variety of mindfulness scales and questionnaires. Study designs often vary as well, with some protocols including a weight reduction component or basic education on diet quality, while others do not. Additional research is needed to determine what behaviors constitute a mindful eating practice so that a more standardized approach can be used in future studies. [1] Standardized tools can help to determine the longer-term impact of mindful eating on health behaviors and disease risk and prevention, and determine which groups of people may most benefit from mindfulness strategies. [1]

Mindfulness is a strategy used to address unfavorable eating behaviors in adults, and there is emerging interest in applying this method in adolescents and children due to the high prevalence of unhealthy food behaviors and obesity in younger ages. More than one-third of adolescents in the U.S. have overweight or obesity. Youth who have overweight/obesity are likely to experience weight-related stigma and bullying by their peers, which in turn can negatively affect eating behaviors and lead to eating disorders. [12] Studies have found that eating disorders are developing at younger ages, with an increased number of children younger than 12 years of age presenting for treatment. [12]

• A review of 15 studies of mindfulness-based interventions in adolescents found that mindfulness techniques were associated with reduced concerns about body shape, less dietary restraint, decreased weight, and less binge eating. [12] However, interestingly, the overall acceptability of the mindfulness-related interventions was rated low by the participants, compared with general health education. It is likely that the way mindful strategies are presented to younger ages needs better understanding as it may be different than in adults. An example could be using new online technologies that are specific to their developmental age and learning ability. The review also found that mindfulness in the form of meditation and mindful breathing can have significant effects on disordered eating through better stress management and reduced overeating caused by depression and anxiety.
• Studies are still scarce in children, but novel programs are emerging. A pilot mindful eating intervention was tested in a low-income school in California involving third-through-fifth grade children including Hispanic and non-Hispanic children. [13] The goal was to foster healthy eating behaviors in the children and their parents. The program included topics such as “Master Mindless Munching,” “Getting to Know Hunger and Fullness,” and “Sensational Senses,” and provided take-home activities to do with their parents. Surveys at the end of the program showed that the children and parents liked the activities, and there was an increase in parents serving nutritious meals and practicing mindfulness during meals (e.g., recognizing when hungry vs. full).

Potential Pitfalls

• Mindful eating is not intended to replace traditional treatments for severe clinical conditions such as eating disorders . Neurochemical imbalances are a risk factor for developing eating disorders such as bulimia and anorexia nervosa, and although mindfulness may be an effective component of a treatment plan, it should not be used as a sole treatment.
• May not be effective as a weight loss strategy on its own, but rather a complement to a weight loss program. Mindful eating embraces making food choices that promote well-being and increasing enjoyment of the eating experience. Traditional weight loss regimens focus on following a structured meal plan that may not necessarily be satisfying or enjoyable. Combining mindfulness with a meal plan under the guidance of a registered dietitian may reduce the risk of emotional overeating or binge eating. [14] Research has not consistently shown that mindfulness strategies lead to weight loss, but this may be due to the study design not including education on healthy eating choices as part of the mindfulness intervention.

Bottom Line

Mindful eating is an approach to eating that can complement any eating pattern. Research has shown that mindful eating can lead to greater psychological wellbeing, increased pleasure when eating, and body satisfaction. Combining behavioral strategies such as mindfulness training with nutrition knowledge can lead to healthful food choices that reduce the risk of chronic diseases, promote more enjoyable meal experiences, and support a healthy body image. More research is needed to examine whether mindful eating is an effective strategy for weight management.

Mindful eating in context of COVID-19

In the meantime, individuals may consider incorporating any number of mindful eating strategies in their daily lives alongside other important measures to help stay healthy during COVID-19 . For example:

• If you’re working from home and find that “office” time blends into all hours of the day, schedule times in your calendar to only eat : a lunch break away from your computer, a reserved time for dinner with your family, etc.
• If you find yourself standing in your pantry or staring in your refrigerator, pause and ask yourself: “am I truly hungry, or am I just bored or stressed?” If hungry, eat. If boredom or stress is the source, reroute your attention to an activity you enjoy, call a friend, or simply spend some time breathing.
• If you have a craving for comfort foods, pause and take a few in-breaths and out-breaths to be fully present with your craving. Take a portion of the food from the container (a handful of chips, a scoop of ice cream) and put it on a plate. Eat mindfully, savoring each bite.

A note about eating disorders : The COVID-19 pandemic may raise unique challenges for individuals with experience of eating disorders. [17] In the U.S., the National Eating Disorders Association has reported a significant increase in calls and messages for help as compared to a year ago. As noted, mindful eating is not intended to replace traditional treatments for severe clinical conditions such as eating disorders. If you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237, or text “NEDA” to 741-741.

A note about food insecurity : Many individuals may be facing food shortages because of unemployment or other issues related to the pandemic. If you (or someone you know) are struggling to access enough food to keep yourself or your family healthy, there are several options to help. Learn more about navigating supplemental food resources .

• Healthy Weight
• The Best Diet: Quality Counts
• Diet Reviews
• Fung TT, Long MW, Hung P, Cheung LW. An expanded model for mindful eating for health promotion and sustainability: issues and challenges for dietetics practice. Journal of the Academy of Nutrition and Dietetics . 2016 Jul 1;116(7):1081-6.
• Hanh TN, Cheung L. Savor: Mindful Eating, Mindful Life . HarperCollins Publishers. 2010.  
• Stanszus LS, Frank P, Geiger SM. Healthy eating and sustainable nutrition through mindfulness? Mixed method results of a controlled intervention study. Appetite . 2019 Oct 1;141:104325.
• Ogden J, Coop N, Cousins C, Crump R, Field L, Hughes S, Woodger N. Distraction, the desire to eat and food intake. Towards an expanded model of mindless eating. Appetite . 2013 Mar 1;62:119-26.
• Katterman SN, Kleinman BM, Hood MM, Nackers LM, Corsica JA. Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: a systematic review. Eating behaviors . 2014 Apr 1;15(2):197-204.
• O’Reilly GA, Cook L, Spruijt‐Metz D, Black DS. Mindfulness‐based interventions for obesity‐related eating behaviours: a literature review. Obesity reviews . 2014 Jun;15(6):453-61.
• Ruffault A, Czernichow S, Hagger MS, Ferrand M, Erichot N, Carette C, Boujut E, Flahault C. The effects of mindfulness training on weight-loss and health-related behaviours in adults with overweight and obesity: A systematic review and meta-analysis. Obesity research & clinical practice . 2017 Sep 1;11(5):90-111.
• Warren JM, Smith N, Ashwell M. A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms. Nutrition research reviews . 2017 Dec;30(2):272-83. *Disclosure: Study  was  funded by Mondelez International.  
• Mason AE, Epel ES, Kristeller J, Moran PJ, Dallman M, Lustig RH, Acree M, Bacchetti P, Laraia BA, Hecht FM, Daubenmier J. Effects of a mindfulness-based intervention on mindful eating, sweets consumption, and fasting glucose levels in obese adults: data from the SHINE randomized controlled trial. Journal of behavioral medicine . 2016 Apr 1;39(2):201-13.
• Daubenmier J, Moran PJ, Kristeller J, Acree M, Bacchetti P, Kemeny ME, Dallman M, Lustig RH, Grunfeld C, Nixon DF, Milush JM. Effects of a mindfulness‐based weight loss intervention in adults with obesity: A randomized clinical trial. Obesity . 2016 Apr;24(4):794-804.
• Miller CK, Kristeller JL, Headings A, Nagaraja H. Comparison of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a randomized controlled trial. Health Education & Behavior . 2014 Apr;41(2):145-54.
• Omiwole M, Richardson C, Huniewicz P, Dettmer E, Paslakis G. Review of mindfulness-related interventions to modify eating behaviors in adolescents. Nutrients . 2019 Dec;11(12):2917.
• Wylie A, Pierson S, Goto K, Giampaoli J. Evaluation of a mindful eating intervention curriculum among elementary school children and their parents. Journal of nutrition education and behavior . 2018 Feb 1;50(2):206-8.
• Tapper K, Shaw C, Ilsley J, Hill AJ, Bond FW, Moore L. Exploratory randomised controlled trial of a mindfulness-based weight loss intervention for women. Appetite . 2009 Apr 1;52(2):396-404.
• Bhutani S, Cooper JA. COVID‐19 related home confinement in adults: weight gain risks and opportunities. Obesity . 2020 May 19.
• Clemmensen C, Petersen MB, Sørensen TI. Will the COVID-19 pandemic worsen the obesity epidemic?. Nature Reviews Endocrinology . 2020 Sep;16(9):469-70.
• Branley-Bell D, Talbot CV. Exploring the impact of the COVID-19 pandemic and UK lockdown on individuals with experience of eating disorders.  Journal of Eating Disorders .  2-2020 Aug;8(44).

Last reviewed September 2020

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Joint interprofessional education of pharmacy and dietetics undergraduates - a scoping review

Anna rudzińska.

1 Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, 2 Jakubowskiego St., building I, 5th floor, 30- 688, Kraków, Poland

2 Faculty of Pharmacy, Jagiellonian University Medical College, 30-688 Krakow, Poland

Agnieszka Skowron

Jerzy gąsowski, karolina piotrowicz, associated data.

All data generated or analysed during this study are included in this published article and its supplementary information files.

Introduction

Interprofessional education (IPE) is an integrative approach that enables collaboration of students of two or more different health professions in aim to acquire skills and competencies related not only to their field of study but also to ensure the standard of care based on collaborative practice. IPE has not yet been explored in relation to collaboration between dietetics-nutrition and pharmacy students, while there is evidence that in many cases nutrition is complementary to pharmacotherapy in the treatment process.

The aim of this scoping review was to gather, describe and discuss all relevant literature regarding joint interprofessional training of pharmacy and dietetics-nutrition undergraduates.

We performed a literature search for studies where IPE between dietetics-nutrition and pharmacy students was described. 2204 articles on this topic were identified. After eligibility assessment, 8 articles were included in the review.

Eight studies were included in the review. Two of these described IPE activities between dietetics and pharmacy students only. The included studies varied in setting, methodology and outcome measures and covered a wide range of topics relevant to clinical practice, such as management of inflammatory bowel diseases, care of the older adults or counselling skills. The most common teaching method was the use of case studies. Some of the included studies did not identify specific learning objectives. The most common way of gathering feedback from participants was through questionnaires and interviews.

Conclusions

IPE of pharmacy and dietetics-nutrition students is feasible and may be beneficial in many aspects related to learning. However, there is no well-established model or standard that would facilitate the implementation of such activities in individual educational institutions.

Collaborative, interprofessional healthcare should become the model for healthcare delivery. According to the World Health Organization (WHO) document published in 2010, the benefits of interprofessional education (IPE) and interprofessional collaborative practice include shorter hospital stays, lower rates of complications and reduced mortality [ 1 ]. IPE is a topic of interest for research on graduate-level education in various aspects of medical care. However, literature reports vary in the models of educational approach evaluated, including, but not limited to, the number of different professions or specialties included, the educational level of participants (graduate or undergraduate), the learning settings, and the educational topics [ 2 – 5 ]. There are also significant differences in the effects measured across studies. These may aim to measure students’ knowledge, skills, or opinions and experiences, as well as clinical skills or effects on the functioning of care systems [ 2 , 4 , 5 ]. Student-oriented outcomes include effects related to specific clinical or professional areas, as well as general collaborative skills, including teamwork or communication skills [ 4 , 6 , 7 ].

In recent years, there has been a growing emphasis on incorporating elements of interdisciplinary education into the curricula of medical schools. This has been highlighted by the accreditation committees of medical and nursing schools in the United States, such as the Liaison Committee on Medical Education (LCME) [ 8 ] and the Accreditation Commission for Education in Nursing (ACEN) [ 9 ], which include in their guidelines requirements for teaching aimed at effective collaboration between different professions. The Accreditation Council for Pharmacy Education (ACPE) publishes guidelines for accreditation that include a requirement to introduce interprofessional activities aimed at teaching skills such as conflict resolution and recognition of different professional roles [ 10 ]. In the UK, the General Medical Council requires medical schools to provide opportunities for students to work with other health and social care professionals during the course of their studies [ 11 ].

There are well-documented examples of good practice in providing such learning activities for the aforementioned majors, while care teams in both hospital and community settings are becoming increasingly multi-professional [ 12 ]. Nowadays, pharmacological and nutritional lifestyle interventions are considered important and complementary treatment modalities and pharmacists and dietitians are becoming more common members of these care teams. This creates an area for collaborative learning between dietitian-nutritionists and pharmacists, which may be considered beneficial in training on topics relevant to clinical practice where the required competencies are cross-disciplinary and part of the curriculum overlaps. This approach of combining pharmacological and dietary interventions is reflected in the clinical guidelines for diabetes [ 13 – 15 ], hypertension [ 16 ], dyslipidaemia [ 17 , 18 ], chronic kidney disease [ 19 , 20 ] or exocrine pancreatic insufficiency [ 21 , 22 ].

The two curricula have in common not only the learning outcomes related to knowledge of therapeutic interventions, but also the role of both professions in the health care system. Both dieticians and pharmacists are responsible for delivering elements of health education in many European countries. Tasks that used to be carried out mainly by doctors and nurses are now largely carried out by members of both professions. This creates favourable conditions for learning using interprofessional education methods. Dietetics and pharmacy students can transfer knowledge on chronic disease management to each other and support each other in acquiring skills for effective communication with other members of the healthcare team and, most importantly, with the patient. Such an approach at the undergraduate level can lay a solid basis for future professional collaboration.

The purpose of this scoping review is to gather, describe and discuss all relevant literature regarding joint interprofessional training of pharmacy and dietetics-nutrition undergraduates with particular focus on learning settings, methods, topics, and outcome measures of joint learning used in research.

We used the extended definition of IPE proposed by Centre for the Advancement of Interprofessional Education (CAIPE), according to which IPE can be defined as occasions when members or students of two or more professions learn with, from and about each other to improve collaboration and the quality of care and services [ 23 ].

We decided to conduct this review in accordance with scoping review methodology, following PRISMA Extension for Scoping Reviews [ 24 ].

Inclusion/exclusion criteria

We included each study that examined the interprofessional education initiatives involving pharmacy students and dietetics-nutrition students.

We excluded studies where:

• students of either pharmacy or dietetics-nutrition were not included;
• the majority (> 50%) of the group were postgraduates;
• it was uncertain, whether dietetics-nutrition and pharmacy students had the opportunity to work together;
• described learning outcomes of interprofessional learning activity were unrelated with future working environment and patient care (e.g. language courses, time management training).

During the screening stage, we considered only publications in English and Polish. We excluded narrative reviews, conference abstracts, letters, opinions, and editorials.

Search strategy

We conducted systematic search of 3 medical databases: Medline (via PubMed), Cochrane Library and Embase with following queries:

• For PubMed and Cochrane: (((((((((((dietician) OR (nutritionist)) OR (dietitian)) OR (dieticians)) OR (nutritionists)) OR (dietitians)) OR (dietetics student)) OR (dietetics students)) OR (“Dietetics“[Mesh]))) AND ((((((pharmacist) OR (pharmacists)) OR (Pharmacy student)) OR (Pharmacy students)) OR (“Students, Pharmacy“[Mesh]))))
• For Embase: ((‘pharmacist’/exp OR pharmacist) OR ‘pharmacy education’/exp OR ‘pharmacy student’/exp) AND ((‘dietitian’/exp OR ‘dietitian’) OR ‘dietetics’/exp OR ‘dietetics student’/exp).

Search results are current as of May 17, 2023.

The selection of relevant studies was carried out independently by two researchers with didactic experience (PG, MPharm and AR, Master of Dietetics) in three step eligibility assessment process compliant with PRISMA Statement Extension for Scoping Reviews [ 24 ]. After the removal of duplicates, we screened titles and abstracts of identified literature. In the next step full texts have been screened. After selection of studies, we additionally reviewed the reference lists of the included full texts and checked the manuscripts citing the retrieved papers. Any disagreements on the inclusion of the study were resolved by discussion with third researcher with high level of competence in university-level teaching, research, and clinical experience (KP; MD, PhD).

Of the initial 2204 records screened, we included 8 manuscripts. Details on the sources, reasons for exclusion, and selection process are presented in PRISMA diagram (Fig.  1 ).

The PRISMA flowchart for the scoping review of joint interprofessional education of pharmacy and dietetics undergraduates

In total, 234 students of dietetics and 721 students of pharmacy participated in the included studies. The characteristics of individual studies are compared in Table  1 .

The characteristics of the studies included in the review

NA– Not applicable

Students (majors) involved in the interdisciplinary training

Only in the studies by Wilby et al. and Khalafalla et al. did pharmacy and dietetics students have the opportunity to work together without the participation of students from other disciplines [ 26 , 29 ]. Wilby et al. described a one-day course-based voluntary IPE session in which students were given a case of a patient with Crohn’s disease and aimed to develop a care plan taking into account nutritional and pharmacological issues. Attitudes towards team-based care were assessed using an adapted survey (Heinemann, Schmitt, Farrell and Brallier; 1999). The survey consisted of 11 items measuring attitudes towards interprofessional care [ 26 , 33 ]. 95.1% of students agreed that the team approach improves the quality of patient care and 87.8% agreed that team meetings promote communication between team members from different disciplines. In general, the vast majority of participants agreed that interprofessional care was an applicable and beneficial concept, but there were few items in the questionnaire where opinions were divided. Controversies tended to relate to the leading role of doctors in interprofessional care and whether they had the right to interfere with patient care plans developed by other members of the healthcare team. 56.1% of respondents disagreed with the statement ‘Physicians are natural team leaders’. The other controversial items in the survey were ‘When developing interdisciplinary patient care plans, much time is wasted translating jargon from other disciplines’ (only 56.1% disagreed) and ‘Patients are less satisfied with their care when it is provided by a team’ (only 61.0% disagreed) [ 26 ]. In a study by Khalafalla et al., pharmacy and dietetics students participated in a voluntary university course aimed at improving communication between future health professionals, clarifying roles and developing teamwork skills. The authors did not specify why they chose to include these two professions in the interprofessional course. The teaching method used in this course was team-based learning (TBL) [ 29 ]. Although only pharmacy and dietetics students attended the course, the curriculum was facilitated by a team consisting of a registered dietitian, a clinical pharmacist, a paediatrician and a cardiovascular researcher. The course consisted of four sessions. Three were dedicated to theoretical knowledge on healthy eating, lifestyle and obesity, and the development of soft skills such as motivational interviewing, coaching and cultural competence. In the fourth session, students conducted mock interviews and had the opportunity to receive feedback from the registered dietitian. Student outcomes were assessed using the Interprofessional Collaborative Competencies Attainment Survey (ICCAS). In general, students’ self-perceived competencies increased in all areas assessed. In presenting the results of this study, the authors did not make a comparison between nutrition and pharmacy students [ 29 ].

In other studies, the number of majors varied from five (Watts et al.) [ 32 ] to eleven (Van Digelle et al.) [ 31 ]. The most common major to participate in an interprofessional learning environment was nursing, which was included in every study except the two that included only students of pharmacy and dietetics. Other common majors included were physiotherapy (in three studies) [ 25 , 27 , 31 ], social work and occupational therapy (each in four studies) [ 25 , 27 , 28 , 30 – 32 ] and psychology (in three studies) [ 25 , 28 , 30 ]. Based on the data we obtained from the included manuscripts, none of the authors provided a rationale for the selection of specific majors.

Learning setting and subject

The majority of the described interprofessional initiatives were implemented as university courses (voluntary or compulsory). In two studies an interprofessional clinic, where students could perform their professional roles was set (Kent et al., Watts et al.) [ 25 , 32 ].One study was based in a clinical setting, as the described intervention was interprofessional clinical rotations as part of the curriculum of the participating programmes (Pelham et al.) [ 27 ].

Four studies (Kent et al., Khalafalla et al., Bhattacharya et al., Van Diggele et al.) mentioned specific learning outcomes achieved by students upon completion of the course [ 25 , 29 – 31 ]. Six of the included studies defined subject areas (e.g., childhood obesity) or skills that students were expected to develop through participation in a course (e.g., cultural competency). In the study by Kent et al. students worked in an outpatient clinic for older adults, and the study aimed to report learning outcomes related to interprofessional collaboration in this specific setting [ 25 ]. In the study by Wilby et al., nutrition and pharmacy students worked on a case study of a patient with Crohn’s disease, but no learning objectives or specific topics were mentioned. In the study by Reitsma et al. no specific learning outcomes were mentioned, but the authors mentioned that the case studies used during the course reflected patients referred to their local clinics, e.g. patients with cancer, human immunodeficiency virus, Alzheimer’s disease, a teenager with an eating disorder and older adults. The project was planned with the involvement of a multidisciplinary team of teachers from six different health professions [ 26 ]. In the study by Khalafalla et al. the learning outcomes were defined but only related to the different aspects of nutrition education and motivational interviewing and not to the interdisciplinary practice of pharmacists and dietitians. Topics covered in the course included obesity, healthy nutrition, and lifestyle, coaching and motivational interviewing skills, and cultural competency [ 29 ]. The study by Bhattacharya et al. was part of the Geriatrics Champions Programme (GCP), a multidisciplinary project designed to train health professionals in different aspects of geriatric care. Thirty learning objectives were divided into eight domains: special considerations in geriatric care; medication management; cognitive, affective and behavioural health; complex or chronic illness in older adults; palliative and end-of-life care; hospital patient safety; transitions of care; ambulatory care. The domains were based on the American Geriatrics Society Internal Medicine-Family Medicine (IM-FM) Residency Competencies. Learning objectives within each domain were adapted for each specialty involved in interprofessional learning [ 30 ]. In study by van Diggele et al. three learning outcomes related to interprofessional collaboration were defined. The manuscript lacked in information on specific topics covered during the course [ 31 ]. Studies by Watts et al. and Pelham et al. lacked in information on learning outcomes provided by described courses [ 27 , 32 ].

Learning approach

Two of the included studies (Kent et al., Watts et al.) used the service-learning (SL) method [ 25 , 32 ]. Service-learning is a learning approach that combines theoretical knowledge gained in an academic setting with practical outcomes that benefit community members in some way. The important parts of service-learning are established learning objectives that meet the needs of the beneficiaries, reflection on the learning experience, reciprocity between beneficiaries and learners so that both parties have the opportunity to learn and teach, and structuring of the learning experience [ 34 ]. In Kent et al. and Watts et al. studies SL was used to create student-led clinics. In a study by Kent et al., the student-led clinic aimed to address the needs of senior citizens being discharged from hospital. Students from different disciplines formed interdisciplinary teams and provided advice and, if an unmet health need was identified, wrote a recommendation to the patient’s GP. After each day students presented each case study to other participants [ 25 , 32 ]. The study by Watts et al. aimed to compare face-to-face mobile community clinics run by students from different professions with the experience of a virtual student-run clinic. While the online clinic sessions were conducted using case studies and real patients were not present during the course, the face-to-face mobile clinics involved community members, particularly underserved older adults, and were offered in assisted living and senior centres. During the patient’s visit to the clinic, students collected health and dietary information, carried out supervised medication reconciliation and assessed the need for social support services. Debriefing sessions were held after the clinics to allow students to discuss the impact of interdisciplinary medical practice [ 32 ].

Case-based learning was the main intervention described in three of the included manuscripts (Wilby et al., Reitsma et al., van Diggele et al.) [ 26 , 28 , 31 ]. Case-based learning is a structured teaching approach that aims to prepare students for the future practice using clinical cases [ 35 ]. In the study by Reitsma et al., students participated in weekly meetings to discuss treatment approaches from the perspective of different health professions. The authors aimed to assess team dynamics and identify students who took on leadership roles during the intervention, as the course lasted 4–6 weeks. The number of nutrition and pharmacy students who took a leadership role during the meeting increased between the first and last meeting of the course [ 28 ]. In the van Diggele et al. study, students were asked to solve a case study and produce a video of their case management and treatment plan for this particular patient. The results of an intervention were evaluated using thematic analysis of the qualitative data. The following themes were identified in students’ responses to an open-ended question “What was most beneficial to your learning?“: opportunity to practice working in an interprofessional team, peer learning and collaboration (for both dietetics and pharmacy students), role clarification (for pharmacy students), perspectives of other disciplines in patient management (for dietetics students) [ 31 ].

The study by Khalafalla et al. used the team-based learning method, previously defined in this article [ 29 ]. The main components of this teaching approach are individual student preparation, individual and team Readiness Assessment Tests (tRATs), and in-class assignments requiring team-based decision making [ 36 ]. The second manuscript that described an intervention based on a team-based learning approach was the study by Bhattacharya et al. The intervention studied was a 24-month course in geriatrics led by facilitators from different faculties. The sessions were structured and consisted of individual and team readiness assessment tests, case studies, discussions and feedback. Before each session, students had access to online materials such as articles and patient cases. Participation in discussions and other activities was rewarded with points, and the team with the highest score received a prize at the end of the academic year [ 30 ].

Measure of outcomes

Two studies used qualitative methods to assess the outcomes of the educational intervention delivered. (Kent et al., Pelham et al.) [ 25 , 27 ]. The majority of included studies used both qualitative and quantitative approaches to the effectiveness and/or usefulness of the intervention for learners. (Reitsma et al., Khalafalla et al., Bhattacharya et al., Van Diggele et al.) [ 28 – 31 ]. In the Watts et al. and Wilby et al. studies, the only tool used to measure outcomes was a validated questionnaire [ 26 , 32 ]. One study analysed clinical workplace providers’ experiences with IPE (Pelham et al.) [ 27 ], one (Kent et al.) mentioned both students’ and educators’ perspective, while other focused on students’ experiences [ 25 ]. A comparison of the included studies in terms of used measures of outcomes is presented in Table  2 .

Measures of outcomes used in the studies included in the review

ICCAS - Interprofessional Collaborative Competencies Attainment Survey

We identified eight manuscripts relating to the described interprofessional learning for dietetics and pharmacy students. Of the included studies, two focused exclusively on dietetics and pharmacy students. Clinical teaching (particularly including geriatrics, gastroenterology, obesity, infectious diseases, oncology), cultural competence and interprofessional collaboration were identified as areas where interprofessional learning for dietetics and pharmacy students could be considered useful. However, some of the included studies did not identify specific learning objectives that would be useful in optimising future collaborations between pharmacy and nutrition or dietetics students. The included studies varied in setting, methodology and outcome measures and covered a wide range of topics relevant to clinical practice. In the included studies, case-based learning was the most commonly used teaching method. The use of this approach allows students from different disciplines to be involved in the care of the patient within their area of expertise, while encouraging interdisciplinary discussion of case management.

In the study by Wilby et al. [ 26 ], which included only dietetics and pharmacy students, authors draw attention to the important issue of involving all potential members of the interprofessional care team in interprofessional learning activities. On the one hand, such an approach would create an environment for more complex collaboration, and on the other hand, joint work between two health professions allows students to become better acquainted with the specifics of a particular health profession. What is more, in this study, only 44% of the students surveyed felt that doctors were natural leaders of the care team. It is also possible that working in teams made up exclusively of two professions allowed them to take on a significant amount of responsibility that would otherwise have been shared between team members.

This finding is in line with what was found in another study on IPE. Mei-Chi Ho et al. [ 37 ] conducted a study involving nursing and physiotherapy students. At the end of the study, the participants described a better recognition of the roles of the different health professions and how they complement each other. The students emphasised that doctors may not have sufficient knowledge of subjects that are directly related to other professions, and therefore achieved better role clarification. Similar observations about collaboration between pairs of different medical professions suggest that it may be worth exploring the potential benefits of collaboration in interprofessional, yet less diverse groups, with the aim of achieving better role awareness and encouraging communication between groups of professionals who traditionally do not share the decision-making process in patient care.

None of the papers justified why particular groups of students were included in the study. To our knowledge, there are no guidelines on this aspect of setting up interprofessional learning groups. An important observation from our review is the suggestion that when setting up classes for students of different professions, it is important to ensure that the learners are provided with educational material that allows to demonstrate the skills of each of the professions included in the study. It is also important to identify thematic areas that can be used as a basis for interdisciplinary activities. The included studies show that a variety of topics can be explored by dietetics-nutrition and pharmacy students in collaborative educational environment. The themes identified in our review where dietetics and pharmacy students collaborated were geriatrics, gastroenterology, infectious diseases and oncology, and obesity. Students also achieved learning outcomes related to cultural competence, motivational interviewing and health coaching. In the study involving only dietetics and pharmacy students, topics included managing the treatment process of a patient with Crohn’s disease and developing soft skills useful in counselling. The case of a patient with Crohn’s disease may be used to illustrate the areas in which students from these disciplines can work together. Crohn’s disease is often associated with the need for enteral or parenteral nutrition. It is essential that at least four professionals are involved in the process of managing the patient’s nutritional needs: a medical doctor, a nurse, a dietitian and a pharmacist [ 38 ]. For this reason, the management of inflammatory bowel diseases seems to be a good field for joint competence development for dietitians and pharmacists. Another area of clinical practice where interprofessional training of dietitians and pharmacists seems relevant is geriatric care, including the management of nutrition-related adverse effects of medications. It is known that anorexia [ 39 ] of ageing can be caused by some groups of prescribed and over-the-counter medications as well as polypharmacy, which causes drug-drug interactions. By working together, dietitians and pharmacists can identify the problem of loss of appetite and resolve it by suggesting deprescribing or changing the schedule of medications and meals. An education that includes the above fields allows for the systematic development of skills from the higher levels of Bloom’s Taxonomy [ 40 ] as students are not only aware of the presence of other health professions (remember), but also have the opportunity to familiarise themselves with their competencies and identify challenges that require collaboration (understand), implement protocols of practice (apply), draw conclusions on the relevance of cooperation (analyze), discuss the advantages and disadvantages of implemented solutions (evaluate), and propose innovative solutions to patient care based on the skills and knowledge of all team members (create). One of the examples of the collaboration between postgraduate dietitians and pharmacists regarding remember and understand levels of Bloom’s taxonomy is the study by Kizaki et al. [ 41 ]., in which pharmacists and dietitians were asked to rate their feelings about the availability of dietary advice in pharmacies in Japan. When surveyed, 70% of pharmacists found this type of service useful. Pharmacists also agreed that the availability of dietary advice reduces the number of medicines a patient has to take. More than 80% of pharmacists thought that the number of pharmacies offering dietary advice would increase in the future. The successful implementation of such services in Japan, followed by a satisfactory level of mutual recognition of the competences of each profession, leads to the conclusion that there is an area for collaboration between practitioners of these two professions in relation to the higher levels of Bloom’s Taxonomy model. This is also in line with the implementation of the patient-centred model of care, as integrated education at undergraduate level seems a reasonable way to build skills and awareness that are crucial for future successful collaboration between health professions to achieve high standards of patient-centred care. In such patient-centered care model, patients’ preferences, goals and beliefs take precedence over medical paternalism. This often requires a shift from a disease-centred approach, which promotes the central role of the physician, to a perspective in which other needs of the patient are considered equally important, allowing other health-related professions to take the lead. As patient treatment is often influenced by nutritional status and polypharmacy, the added value of IPE between dietitians and pharmacists would be to teach such approaches from the outset, rather than putting health professionals from different disciplines in a situation where they have to start working together as a team without proper training on how to do so. Another important component of IPE approach is promoting an inclusive attitude where uncertainties are resolved with respect for each profession and attempts are made to establish common communication practices. In such an approach, IPE is not only a teaching format aimed at the acquisition of knowledge related to the future profession, but also an opportunity for students of different disciplines to learn communication beyond the boundaries of the profession. In this way, IPE is more about giving students a space to share their thoughts, discuss and collaborate, rather than teaching them the principles of effective communication in the artificial conditions of a classroom.

The results presented by the authors of the included studies tended to focus on the overall student experience. Most projects did not use standardised assessment tools. In addition, only one study considered teachers’ perceptions of the interprofessional education experience (Kent et al.) [ 25 ] and one study considered employers’ perceptions (Pelham et al.) [ 27 ]. An important direction for further research in the area of interprofessional education of dietetics and pharmacy students seems to be not only the student experience, but also the evaluation of the educational process by experienced educators and, in later stages, by potential employers. Involving employers in the evaluation of the usefulness of interprofessional educational activities may help to identify further areas where this collaboration could have long-term benefits. Another area where further research could be undertaken is the element of evaluating the uptake of leadership by students on different courses, introduced in one of the included articles. The effectiveness of the educational interventions described could then be assessed through a shift in the perception of the relevance of one’s role in the patient care process and the willingness to take initiative and responsibility for the outcomes achieved.

The included studies represented a wide range of educational and research approaches. In view of the conclusions drawn by the authors, we have decided to summarise the implications for the further planning of joint educational and research activities for students of nutrition and dietetics and pharmacy (Table  3 .).

Suggested actions to improve interprofessional collaborative education and research for dietetics and pharmacy students

Our scoping review needs to be considered in the context of its limitations. All included papers provided information on the type of learning project evaluated. However, only 4 of them (Kent et al., Khalafalla et al., Bhattacharya et al., Van Diggele et al.) reported specific learning outcomes. These outcomes differed significantly between studies [ 25 , 29 – 31 ]. In other studies authors included only a description of the skills (Wilby et al.) [ 26 ] or competencies (Reitsma et al.) [ 28 ] that the students should acquire during the training, but these were not specified or comparable between studies.

Several published studies addressed the issue of IPE jointly in pharmacy and dietetics-nutrition. The studies ranged in setting, methodology and outcome measures. Although the topics of educational courses varied, most of the included studies used case studies as the main teaching method during the courses described, two of the studies used student-led clinics and other types of problem-based learning. All of the teaching strategies used focused on students taking action and being encouraged to work together. The IPE, as delivered in the included studies, was feasible and was providing measurable benefit. The students who took part experienced improved skills both in individual soft competences and teamwork.

Changing paradigms of patient care lead to changes in educational approaches. Despite methodological differences, the reviewed papers suggest that IPE is a viable educational option. Its implementation can facilitate teamwork that is better adapted to the changing needs of the patient and thus lead to improvements in patient care. The main challenge to the wider use of IPE among students of dietetics-nutrition and pharmacy appears to be the lack of scientific evidence to support the decisions needed to carefully plan and implement IPE activities. However, the available data suggest that IPE in these programmes is feasible in a variety of settings and can be beneficial for learners.

Acknowledgements

Not applicable.

Abbreviations

Author contributions.

AR and PG contributed equally to this paper. They established inclusion/exclusion criteria, developed search strategy, conducted screening and articles review. They also extracted data from included papers. KP consulted AR and PG throughout the entire process, resolved disagreements on the inclusion of the study. AR, PG, KP, AS, JG analyzed and interpreted data. All authors reviewed manuscript.

Data availability

Declarations.

The authors declare no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Clinical nutrition degree overview

In this article:, what is a clinical nutrition degree, program options, skills you&rsquo;ll learn, what can you do with a clinical nutrition degree.

A Clinical Nutrition degree program is a specialized educational track within the field of nutrition that focuses on the practical application of nutrition science in clinical settings to promote health and manage medical conditions. In these programs, students study the relationship between diet and health, with a particular emphasis on the prevention and treatment of diseases through dietary interventions. The curriculum typically covers topics such as medical nutrition therapy, nutritional assessment, dietetics, and patient counseling, providing students with the knowledge and skills necessary to work as healthcare professionals specializing in clinical nutrition.

Students in Clinical Nutrition degree programs learn how to assess individuals’ nutritional needs and develop personalized dietary plans tailored to their specific health conditions and goals. They study the biochemical and physiological aspects of nutrition, as well as the role of nutrients in maintaining health and preventing chronic diseases such as diabetes, cardiovascular disease, and obesity. Clinical Nutrition programs also emphasize evidence-based practice, teaching students to evaluate research findings and apply them to real-world clinical scenarios to optimize patient outcomes.

Upon completion of a Clinical Nutrition degree program, graduates are prepared for careers as registered dietitians (RDs) or nutritionists specializing in clinical practice. They may work in hospitals, outpatient clinics, long-term care facilities, community health centers, or private practice settings, collaborating with healthcare teams to provide nutrition assessments, develop treatment plans, and educate patients about healthy eating habits.

Clinical Nutrition degree programs offer a range of educational options designed to prepare students for careers in healthcare settings, with a focus on applying nutrition science to promote health and manage medical conditions.

• Bachelor’s Degree in Clinical Nutrition: A Bachelor’s Degree in Clinical Nutrition provides a comprehensive education in the fundamentals of nutrition science and dietetics, with a focus on the practical application of nutrition knowledge in clinical settings. These programs typically include coursework in medical nutrition therapy, nutritional assessment, dietetics, and food science, as well as supervised practicum experiences to develop practical skills in patient care and counseling.
• Master’s Degree in Clinical Nutrition: A Master’s Degree in Clinical Nutrition offers advanced coursework and research opportunities for students seeking to specialize in clinical practice or pursue leadership roles in healthcare settings. These programs may include concentrations in areas such as pediatric nutrition, geriatric nutrition, or oncology nutrition, and often require a thesis or capstone project related to a specific area of interest within clinical nutrition.
• Dietetic Internship Programs: Dietetic internship programs provide supervised practice experiences for students completing their education to become registered dietitians (RDs). These programs typically include rotations in clinical nutrition, community nutrition, and food service management settings, allowing students to apply their knowledge and skills in real-world healthcare environments under the guidance of experienced professionals.
• Postgraduate Certificate Programs: Postgraduate certificate programs in Clinical Nutrition are designed for individuals who already hold a bachelor’s or master’s degree in a related field and wish to specialize in clinical nutrition practice. These programs offer focused coursework and practical training in areas such as medical nutrition therapy, nutritional assessment, and dietetics, providing a pathway to become a registered dietitian or advance in a career in clinical nutrition.

In Clinical Nutrition degree programs, students develop a diverse set of skills essential for providing effective nutritional care in clinical settings. These skills include:

• Nutritional Assessment: The ability to evaluate individuals’ nutritional status through methods such as dietary analysis, anthropometric measurements, and biochemical tests.
• Medical Nutrition Therapy: Proficiency in developing and implementing personalized dietary plans to manage various medical conditions, such as diabetes, cardiovascular disease, and gastrointestinal disorders.
• Patient Counseling: Effective communication skills to educate and motivate patients about healthy eating habits, dietary modifications, and lifestyle changes to achieve their health goals.
• Interdisciplinary Collaboration: Collaboration with healthcare professionals, including physicians, nurses, and therapists, to integrate nutrition interventions into comprehensive patient care plans.
• Evidence-Based Practice: Critical thinking skills to evaluate research findings and apply evidence-based nutrition guidelines and recommendations in clinical decision-making.
• Cultural Competence: Understanding of cultural and socioeconomic factors influencing dietary habits and preferences, and the ability to tailor nutrition counseling to diverse patient populations.
• Food Service Management: Knowledge of food safety regulations, menu planning, and food preparation techniques to ensure the delivery of nutritious meals in healthcare facilities.
• Professional Ethics: Adherence to ethical standards and professional guidelines in clinical practice, including confidentiality, informed consent, and patient autonomy.

With a Clinical Nutrition degree, individuals can pursue various career paths in healthcare settings, specializing in providing nutritional care to patients with medical conditions. Here are some potential career options:

• Registered Dietitian (RD): Graduates of Clinical Nutrition programs can become registered dietitians after completing a dietetic internship and passing the national registration examination. As RDs, they work in hospitals, clinics, and long-term care facilities, assessing patients’ nutritional needs, developing personalized diet plans, and monitoring their progress to improve health outcomes.
• Healthcare Administrator : Some Clinical Nutrition professionals transition into healthcare administration roles, overseeing nutrition services, food service operations, or wellness programs within healthcare organizations. They may be responsible for managing budgets, staffing, quality assurance, and regulatory compliance to ensure the delivery of high-quality nutritional care to patients.
• Clinical Nutrition Specialist: Clinical Nutrition Specialists focus on providing advanced nutritional care to patients with complex medical conditions, such as cancer, renal disease, or eating disorders. They may work in specialty clinics, research institutions, or outpatient settings, collaborating with healthcare teams to optimize patients’ nutritional status and treatment outcomes.
• Nutrition Educator: Some Clinical Nutrition graduates work as nutrition educators, developing and delivering educational programs on healthy eating habits, disease prevention, and nutrition management. They may work in community health centers, schools, or corporate wellness programs, promoting health and wellness through nutrition education and outreach initiatives.
• Nutrition Consultant: Nutrition Consultants provide expert advice and guidance on nutrition-related matters to individuals, organizations, or businesses. They may work independently or as part of consulting firms, offering services such as dietary counseling, menu planning, nutrition analysis, and wellness program development to clients seeking to improve their health or dietary practices.
• Clinical Researcher: Clinical Nutrition graduates with an interest in research can pursue careers as clinical researchers, conducting studies to investigate the effectiveness of nutrition interventions in managing medical conditions or improving health outcomes. They may work in academic institutions, healthcare organizations, or research centers, contributing to the evidence base for clinical nutrition practice and policy.

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Clinical Nutrition

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